DEREK GARN RODEBACK (NPI# 1053751032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053751032 |
| Entity Type | Individual |
| Full Name | DEREK GARN RODEBACK |
| Credential | D.O. |
| Practice Address |
350 Broadway St Ste 202 Boulder CO 80305 |
| Mailing Address |
350 Broadway St Ste 202 Boulder CO 80305-3338 |
| Practice Telephone | 7204630567 |
| Practice Fax Number | 3034945371 |
| Mailing Telephone | 7204630567 |
| Mailing Fax Number | 3034945371 |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2019-04-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | DR.0061855 | CO | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | 14082 | CA | Allopathic & Osteopathic Physicians |
| Y | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
DR.0061855 | CO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 902 Lakeview Ave, Pueblo, CO 810043597 | 7195575855 | 7195575097 |
| Street Address |
350 BROADWAY ST STE 202 |
| City | BOULDER |
| State | CO |
| Zip Code | 80305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437130424 | Timothy Joseph Mazzola | Family Medicine | 350 Broadway St Ste 202, Boulder, CO 80305 | 2005-11-08 |
| 1497261523 | Regenerative Orthopedics & Sports Medicine of Boulder Co Pllc | Orthopaedic Surgery | 350 Broadway St Ste 202, Boulder, CO 80305-3338 | 2017-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538698923 | Carian Mclean | Registered Nurse | 1013 Berea Dr, Boulder, CO 80305 | 2017-06-08 |
| 1548629439 | Kimberly Norquist | Dental Hygienist | 661 S. Broadway St, Boulder, CO 80305 | 2016-02-19 |
| 1871981266 | Kathleen Anne Stone | Registered Nurse | 3680 Silver Plume Lane, Boulder, CO 80305 | 2015-01-07 |
| 1104235779 | Joyce Larson | Marriage & Family Therapist | 1190 S Lashley Ln, Boulder, CO 80305 | 2014-08-07 |
| 1982035788 | Virginia Pleasants Vandenbergh | Counselor | 4760 Ludlow St, Boulder, CO 80305 | 2013-12-03 |
| 1790992550 | Jasjit Singh Gill | Pharmacist | The Apothecary Pharmacy - University of Colorado, 350 Broadway Ste. 50, Boulder, CO 80305 | 2007-05-17 |
| 1477768299 | Stephen W Laycock | Dentist | 4150 Darley Ave., Suite 7, Boulder, CO 80305 | 2007-05-14 |
| 1871614560 | Steven Leslie Buffer | Dentist | 385 Broadway St, Boulder, CO 80305 | 2007-04-02 |
| 1801927793 | Jeffrey Dann | Acupuncturist | 3400 Table Mesa Drive, Ste. 205, Boulder, CO 80305 | 2007-03-09 |
| 1235292145 | Pharmaca Integrative Pharmacy | Exclusive Provider Organization | 645 South Boulder, Boulder, CO 80305 | 2006-12-19 |
| Find all providers in zip 80305 | ||||
| Taxonomy Code | 2081S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Sports Medicine |
| A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. |
| Notes: Source: American Board of Medical Specialties, 2009. www.abms.org [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770085243 | Laura Michelle Boucher | Physical Medicine & Rehabilitation | 5387 Manhattan Cir, Ste 200, Boulder, CO 80303 | 2018-03-01 |
| 1437677598 | Raining Sun Inc. | Physical Medicine & Rehabilitation | 3550 Frontier Ave Ste D, Boulder, CO 80301-2430 | 2017-09-08 |
| 1912512385 | Friday Physical Therapy | Physical Medicine & Rehabilitation | 2749 Iris Ave, Boulder, CO 80304-2433 | 2020-09-12 |
| 1154950814 | Kyle S Kahl | Physical Medicine & Rehabilitation | 5603 Arapahoe Ave Ste 5, Boulder, CO 80303-1377 | 2020-04-05 |
| 1083248462 | Jordan Nicole Bradfield | Physical Medicine & Rehabilitation | 3000 Center Green Dr Ste 110, Boulder, CO 80301-2364 | 2020-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366080111 | Julie Anne Williams | Physical Medicine & Rehabilitation | 1003 S Honeysuckle Dr, Pueblo West, CO 81007-6311 | 2019-12-11 |
| 1255984142 | Christopher Whitmore | Physical Medicine & Rehabilitation | 5801 S Quebec St Ste 100, Greenwood Village, CO 80111-2010 | 2019-07-19 |
| 1861974685 | Natalie Ormond | Physical Medicine & Rehabilitation | 929 N Pearl St, Denver, CO 80203-3213 | 2018-08-29 |
| 1831594662 | Katharine Janette Ferraro | Physical Medicine & Rehabilitation | 1504 N Hancock Ave, Colorado Springs, CO 80903-2623 | 2014-10-22 |
| 1134530033 | Lauren Rudolph | Physical Medicine & Rehabilitation | 2555 E 13th St Ste 105, Loveland, CO 80537-5134 | 2014-05-13 |
| 1174947741 | 3g Medical Consultant | Physical Medicine & Rehabilitation | 421 Security Blvd, Colorado Springs, CO 80911-1728 | 2014-02-18 |
| 1922149384 | Heidi Marie Fink | Physical Medicine & Rehabilitation | University of Denver, 2201 East Asbury Ave., Rm 1312, Denver, CO 80208-0001 | 2007-02-09 |
| 1760543490 | Steamboat Spine and Sports Inc. | Physical Medicine & Rehabilitation | 1560 Pine Grove Rd Ste B, Steamboat Springs, CO 80487 | 2006-12-13 |
| 1972532208 | Robert Baumgarten | Physical Medicine & Rehabilitation | 405 W Tomichi Ave, Gunnison, CO 81230-2713 | 2006-06-30 |
| 1679102396 | Sara Peterson | Physical Medicine & Rehabilitation | 1024 Central Park Dr, Steamboat Springs, CO 80487-8813 | 2020-04-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.