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General NPI Number Information
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NPI Number | 1487566196
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Entity Type | Organization
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Legal Business Name | COLORADO FITNESS PHYSIO, PLLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 505 THUNDERBIRD DRIVE
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City | BOULDER
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State | CO
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Zip | 80303
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Country | US
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Telephone | 855-749-7461
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 CANTERBURY RD
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City | RALEIGH
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State | NC
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Zip | 27608-1110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MARC DOUEK
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Credential | PT, MPT
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Telephone | 919-327-7697
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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 | NULL
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