Individual
OWEN MACKENZIE ROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
12080 BELLAIRE WAY, THORNTON, CO 80241-3600
(303) 450-2700
Mailing address
515 S 42ND ST, BOULDER, CO 80305-5906
(443) 876-2613
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0014924
CO
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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