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General NPI Number Information
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NPI Number | 1518848886
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Entity Type | Organization
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Legal Business Name | ROOTED SOMA THERAPY COLLECTIVE
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1375 KEN PRATT BLVD STE 300J
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City | LONGMONT
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State | CO
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Zip | 80501-7078
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Country | US
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Telephone | 918-636-0449
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Fax |
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Provider Business Mailing Address
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Address Line | 6228 WATERMAN WAY
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City | FREDERICK
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State | CO
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Zip | 80516-9777
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Country | US
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Telephone | 918-636-0449
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AIYLA COOK
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Credential | LPCC, DD, PRT, CYT
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Telephone | 918-636-0449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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