MEDICARE: COLORADO SPINE THERAPY, LLC

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	2251X0800X	Orthopedic Physical Therapist	5012	CO

General Provider Information

NPI Number	:	1679766984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPINE THERAPY, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 21150
Second Line	:	FLATIRONS PRACTICE MANAGEMENT
City	:	BOULDER
State	:	CO
Zip	:	80308-4150
Country	:	US
Telephone Number	:	303-546-9158
Fax Number	:	303-691-1142

Provider Business Practice Location Address
First Line	:	1385 S COLORADO BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3304
Country	:	US
Telephone Number	:	303-842-5614
Fax Number	:	303-691-1142

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. STEFAN JH VAN DUURSEN
Credential	:	PT
Telephone Number	:	303-842-5614

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	12/16/2024

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Directions to “COLORADO SPINE THERAPY, LLC ” Practice Location

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