MEDICARE: PHYSICAL AND REGENERATIVE MEDICINE OF DENVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1164060471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL AND REGENERATIVE MEDICINE OF DENVER

Provider Business Mailing Address
First Line	:	950 17TH ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2803
Country	:	US
Telephone Number	:	855-734-3727
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 17TH ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2803
Country	:	US
Telephone Number	:	855-734-3727
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RACHEL ANDERS
Credential	:
Telephone Number	:	855-734-3727

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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