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General NPI Number Information
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NPI Number | 1245135276
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Entity Type | Organization
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Legal Business Name | CRANIAL CARE PEDIATRICS LLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 3030 S COLLEGE AVE UNIT 210
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City | FORT COLLINS
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State | CO
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Zip | 80525-2557
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Country | US
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Telephone | 303-325-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 4882 S NEWPORT ST UNIT 925
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City | DENVER
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State | CO
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Zip | 80237-3692
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Country | US
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Telephone | 303-325-1841
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHOTIST
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Name | GINA RETALLACK
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Credential | CO
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Telephone | 303-325-1841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | NULL
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