Provider Demographics
NPI:1902983950
Name:MEROMED PHYSIOTHERAPY CENTRE, LLC
Entity Type:Organization
Organization Name:MEROMED PHYSIOTHERAPY CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OETOMO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LAC
Authorized Official - Phone:303-683-8338
Mailing Address - Street 1:8955 RIDGELINE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2355
Mailing Address - Country:US
Mailing Address - Phone:303-683-8338
Mailing Address - Fax:303-683-8809
Practice Address - Street 1:8955 RIDGELINE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2355
Practice Address - Country:US
Practice Address - Phone:303-683-8338
Practice Address - Fax:303-683-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO978171100000X
CO35792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty