Healthcare Provider Details

I. General information

NPI: 1083609234
Provider Name (Legal Business Name): RELIEVA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 AUTOMATION WAY B-1
FORT COLLINS CO
80525-3446
US

IV. Provider business mailing address

4025 AUTOMATION WAY B-1
FORT COLLINS CO
80525-3446
US

V. Phone/Fax

Practice location:
  • Phone: 970-472-1072
  • Fax: 970-472-1071
Mailing address:
  • Phone: 970-472-1072
  • Fax: 970-472-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2335
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DENNIS J HAZLETT
Title or Position: PRESIDENT
Credential:
Phone: 970-472-1072