=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831834845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPIINROK PHYSIATRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 05/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 GOLDEN RIDGE RD
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-8916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-213-0692
-----------------------------------------------------
Fax | 361-585-4867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1630 30TH ST STE A-336
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80301-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-213-0692
-----------------------------------------------------
Fax | 361-585-4867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN AND OWNER
-----------------------------------------------------
Name | DR. JULIA CARP
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 313-213-0692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------