Healthcare Provider Details

I. General information

NPI: 1245135276
Provider Name (Legal Business Name): CRANIAL CARE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 S COLLEGE AVE UNIT 210
FORT COLLINS CO
80525-2557
US

IV. Provider business mailing address

4882 S NEWPORT ST UNIT 925
DENVER CO
80237-3692
US

V. Phone/Fax

Practice location:
  • Phone: 303-325-1841
  • Fax:
Mailing address:
  • Phone: 303-325-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GINA RETALLACK
Title or Position: OWNER/ORTHOTIST
Credential: CO
Phone: 303-325-1841