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General NPI Number Information
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NPI Number | 1922207133
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Entity Type | Organization
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Legal Business Name | REDROCK PHYSICAL MEDICINE & REHABILIATION PC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 551 KOKOPELLI BLVD UNIT J
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City | FRUITA
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State | CO
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Zip | 81521-6305
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Country | US
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Telephone | 970-858-2585
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Fax | 970-858-2555
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Provider Business Mailing Address
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Address Line | 551 KOKOPELLI BLVD UNIT J
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City | FRUITA
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State | CO
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Zip | 81521-6305
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Country | US
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Telephone | 970-858-2585
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Fax | 970-858-2555
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI TRIPLETT
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Credential |
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Telephone | 970-858-2565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 30888
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License Number State | CO
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