Healthcare Provider Details
I. General information
NPI: 1992450076
Provider Name (Legal Business Name): CASTLE ROCK THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/16/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
19284 COTTONWOOD DR STE 203
PARKER CO
80138-3881
US
IV. Provider business mailing address
2 OAKWOOD PARK PLZ STE 200
CASTLE ROCK CO
80104-1885
US
V. Phone/Fax
- Phone: 720-788-7365
- Fax: 720-294-1426
- Phone: 720-788-7365
- Fax: 720-679-1272
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2251P0200X |
| Taxonomy | Pediatric Physical Therapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225XP0200X |
| Taxonomy | Pediatric Occupational Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
TAYLOR
MARK
PFEIFER
Title or Position: CO-OWNER
Credential: DPT
Phone: 720-788-7365