Healthcare Provider Details

I. General information

NPI: 1215548904
Provider Name (Legal Business Name): EXOATLET INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4582 S ULSTER ST STE 205
DENVER CO
80237-3011
US

IV. Provider business mailing address

4582 S ULSTER ST STE 205
DENVER CO
80237-3011
US

V. Phone/Fax

Practice location:
  • Phone: 720-475-1826
  • Fax:
Mailing address:
  • Phone: 720-475-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BRET BOSTOCK
Title or Position: PRESIDENT
Credential: CO
Phone: 720-475-1826