Healthcare Provider Details

I. General information

NPI: 1326751397
Provider Name (Legal Business Name): THE PHYSIOROOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 W QUINCY AVE
DENVER CO
80235-3010
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-9974
  • Fax: 720-294-0332
Mailing address:
  • Phone: 720-316-9974
  • Fax: 720-294-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER WAYNE ROBL
Title or Position: PRESIDENT, CEO
Credential: DPT
Phone: 720-560-5326