Revo Physiotherapy and Sports Performance

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PTL.0011688 Issued in CO

Legal business name

REVO PHYSIOTHERAPY AND SPORTS PERFORMANCE

Practice address

1855 29TH St
#1168
Boulder, CO 80301-1065

Phone

(412) 848-8278

NPI assigned

Jun 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dane N Delozier, PT, DPT, ATC, PES

Title

Ceo

Phone

(412) 848-8278

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1770965477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 29TH ST",
            "address_2": "#1168",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011065",
            "telephone_number": "412-848-8278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 29TH ST",
            "address_2": "#1168",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011065",
            "telephone_number": "412-848-8278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVO PHYSIOTHERAPY AND SPORTS PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-18",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "DELOZIER",
        "authorized_official_first_name": "DANE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "412-848-8278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, ATC, PES"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CO",
            "license": "PTL.0011688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luciano Retana, DDS MS
• Racine Rettig Jr.
• Emily Rettler, MA
• Revamped by Nutrition
• Kirsten Anne Revitte
• Taylor Revoal
• Bryan J Reynolds, M.D.
• Grace Reynolds
• Robert James Reynolds Jr.
• Shawn Michael Reynolds, MA, LPC, CAC III

• Physical Therapy Clinic/Center in Boulder, CO
• Providers in Boulder, CO by specialty
• Physical Therapy Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.