Basic Information
| Provider Information | |||||||||
| NPI: | 1740682236 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELTRAN | ||||||||
| FirstName: | ROLLIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 NW WALL STREET STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977032800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413894321 | ||||||||
| FaxNumber: | 5413894420 | ||||||||
| Practice Location | |||||||||
| Address1: | 13650 E MISSISSIPPI AVE STE 100B | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800123573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036951338 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2014 | ||||||||
| LastUpdateDate: | 08/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0013017 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.