Healthcare Provider Details

I. General information

NPI: 1538941125
Provider Name (Legal Business Name): COLORADO NEUROFITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 HIGHWAY 73 STE 11
EVERGREEN CO
80439-6238
US

IV. Provider business mailing address

PO BOX 72
CONIFER CO
80433-0072
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-8953
  • Fax:
Mailing address:
  • Phone: 510-282-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARGARET KIMBALL-HODGES
Title or Position: OWNER
Credential: PSY
Phone: 510-282-8953