MEDICARE: ANTHONY VALLES DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0013142	CO

General Provider Information

NPI Number	:	1548643174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY VALLES DPT

Provider Business Mailing Address
First Line	:	535 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1608
Country	:	US
Telephone Number	:	303-777-5580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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