=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669695029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPORTS AND ORTHOPEDIC REHABILITATION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 YOUNGFIELD ST SUITE 150
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-2263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-238-4277
-----------------------------------------------------
Fax | 303-238-4977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 YOUNGFIELD ST SUITE 150
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-2263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-238-4277
-----------------------------------------------------
Fax | 303-238-4977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOUGLAS E HEMLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-238-4277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 20602
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------