Healthcare Provider Details

I. General information

NPI: 1821922139
Provider Name (Legal Business Name): EVAN CHRISTIAN BO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 GRANT ST STE 200
THORNTON CO
80229-4347
US

IV. Provider business mailing address

9025 GRANT ST STE 200
THORNTON CO
80229-4347
US

V. Phone/Fax

Practice location:
  • Phone: 303-292-0034
  • Fax: 720-242-9372
Mailing address:
  • Phone: 303-292-0034
  • Fax: 720-242-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number553056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: