Healthcare Provider Details

I. General information

NPI: 1578496832
Provider Name (Legal Business Name): PHOENIX ORTHOTICS AND PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3650
DENVER CO
80218-1282
US

IV. Provider business mailing address

3950 JOHN F KENNEDY PKWY UNIT 8C
FORT COLLINS CO
80525-3074
US

V. Phone/Fax

Practice location:
  • Phone: 970-694-2971
  • Fax: 970-792-8544
Mailing address:
  • Phone: 720-496-8800
  • Fax: 970-792-8544

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: ELICHA ROBERTS
Title or Position: OWNER
Credential: CPO
Phone: 970-694-2971