=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184574733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROARING FORK REHAB & PERFORMANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2026
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MIDLAND AVE UNIT 250
-----------------------------------------------------
City | GLENWOOD SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81601-9808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-945-4440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MIDLAND AVE UNIT 250
-----------------------------------------------------
City | GLENWOOD SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81601-9808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-945-4440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DREILING JACK GREEN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 316-734-0984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------