Individual
MR. INDRA SOERJA OETOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, LAC
Contact information
Practice address
8955 S RIDGELINE BLVD, SUITE 400, HIGHLANDS RANCH, CO 80129-2362
(303) 683-8338
(303) 683-8809
Mailing address
8955 S RIDGELINE BLVD, SUITE 400, HIGHLANDS RANCH, CO 80129-2362
(303) 683-8338
(303) 683-8809
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
978
CO
2251X0800X
Orthopedic Physical Therapist
3579
CO
Other
Enumeration date
04/28/2006
Last updated
09/11/2025
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