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General NPI Number Information
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NPI Number | 1336622570
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Entity Type | Organization
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Legal Business Name | BOULDER NEUROLOGY AND CONCUSSION PLLC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 275 CENTURY CIR STE 100
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City | LOUISVILLE
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State | CO
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Zip | 80027-9729
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Country | US
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Telephone | 720-738-8738
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Fax | 720-862-2184
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Provider Business Mailing Address
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Address Line | 275 CENTURY CIR STE 100
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City | LOUISVILLE
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State | CO
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Zip | 80027-9729
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Country | US
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Telephone | 720-738-8738
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Fax | 720-862-2184
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALLISON RACHEL GRAY
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Credential | MD
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Telephone | 720-738-8738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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