1083975635 NPI number — CODIE MARIE ROBERTS DPT

Table of content: DR. LUIS ENRIQUE MORALES-BRIGNAC M.D. (NPI 1679596639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083975635 NPI number — CODIE MARIE ROBERTS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CODIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYINGTON
Provider Other First Name:
CODIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083975635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11169 E I25 FRONTAGE RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FIRESTONE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80504-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-600-0370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 MT PYRAMID CT STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-600-0370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004597 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)