Dynamic Athlete PLLC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

Legal business name

DYNAMIC ATHLETE PLLC

Practice address

1790 30TH St Ste 270
Boulder, CO 80301-1085

Phone

(303) 997-1733

NPI assigned

Apr 17, 2023

Organization subpart

No

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

Authorized official

Name

Nicole Allison

Title

Practice Manager

Phone

(303) 997-1733

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aneesh Garg, D.O.

  • Sports Medicine (Internal Medicine) Physician
  • Boulder, CO
  • NPI 1346537370
  Medicare reassignment Care Compare group NPD
• McKenna Graham, PA-C

  • Physician Assistant
  • Boulder, CO
  • NPI 1982459707
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1841986494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 30TH ST STE 270",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011085",
            "telephone_number": "303-997-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 30TH ST STE 270",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011085",
            "telephone_number": "303-997-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC ATHLETE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-997-1733"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rene Michelle Duvent White, MA, LPC, CAC III
• Marek C Dvorak, PH.D
• Kathleen G Dworak, NP-C
• Katherine Marie Dyer, LPCC
• Caitlin Dygulski
• Suzanne Dysart
• Mary Dan Eades, MD
• Michael Robert Eades, M.D.
• Eaglewings Care LLC
• Annilee Eakins

• Sports Medicine (Internal Medicine) Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Sports Medicine (Internal Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.