# CREEKSIDE PHYSICAL MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578601969
- **Authorized official:** DAVID E TANNER D.O (PRINCIPAL CLINICIAN)
- **Authorized official phone:** (303) 494-2705

## Contact information

- **Practice address:** 5387 MANHATTAN CIR, STE 201, BOULDER, CO 80303-4284
- **Practice address phone:** (303) 494-2705
- **Practice address fax:** (303) 494-2706
- **Mailing address:** 5387 MANHATTAN CIR, STE 201, BOULDER, CO 80303-4284
- **Mailing address phone:** (303) 494-2705
- **Mailing address fax:** (303) 494-2706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 38635 | CO | Yes |

## Other

- **Enumeration date:** 02/01/2007
- **Last updated:** 08/04/2025