| Mind Body Sport, Llc | |
|
2121 S Oneida St Ste 600 Denver CO 80224-2555 | |
| (720) 863-6100 | |
| Not Available |
| Full Name | Mind Body Sport, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2121 S Oneida St Ste 600, Denver, Colorado |
| Authorized Official Name and Position | Ian J Palombo (PRESIDENT) |
| Authorized Official Contact | 7208636100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Sport, Llc 2121 S Oneida St Ste 600 Denver CO 80224-2555 Ph: (720) 863-6100 | Mind Body Sport, Llc 2121 S Oneida St Ste 600 Denver CO 80224-2555 Ph: (720) 863-6100 |
| NPI Number | 1497273916 |
|---|---|
| Provider Enumeration Date | 09/05/2017 |
| Last Update Date | 04/20/2021 |
| Certification Date | 04/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497273916 | NPI | - | NPPES |
| 9000172843 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
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