Healthcare Provider Details

I. General information

NPI: 1558481655
Provider Name (Legal Business Name): ROCKY MOUNTAIN REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631
US

IV. Provider business mailing address

1175 58TH AVE STE 202
GREELEY CO
80634-4807
US

V. Phone/Fax

Practice location:
  • Phone: 970-353-1009
  • Fax: 970-353-2275
Mailing address:
  • Phone: 970-495-0300
  • Fax: 970-224-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number32155
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number32155
License Number StateCO

VIII. Authorized Official

Name: NANCY L CUTTER
Title or Position: PRESIDENT
Credential: MD
Phone: 970-353-1009