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General NPI Number Information
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NPI Number | 1982411328
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Entity Type | Organization
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Legal Business Name | INNERROOT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 6143 S WILLOW DR STE 406
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5125
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Country | US
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Telephone | 720-926-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 9011 CLYDESDALE RD
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City | CASTLE ROCK
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State | CO
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Zip | 80108-9102
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Country | US
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Telephone | 303-638-8674
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KRISTIN NICOLE ANDERSON
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Credential | P.T., D.P.T
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Telephone | 720-926-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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