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NPI Code Detail

MEDICARE: MARY PAVLANTOS DPT

MEDICARE:   MARY  PAVLANTOS  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
1225100000XPhysical Therapist10616CO
22081N0008XNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician10616CO

General Provider Information

NPI Number : 1659783850
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY PAVLANTOS DPT
Provider Business Mailing Address
First Line : 2297 DOGWOOD DR
Second Line :
City : ERIE
State : CO
Zip : 80516-7988
Country : US
Telephone Number : 505-400-3234
Fax Number :
Provider Business Practice Location Address
First Line : 956 W CHERRY ST STE 103
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-3047
Country : US
Telephone Number : 720-740-7401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2014
Last Update Date : 01/29/2023

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Directions to “ MARY PAVLANTOS DPT” Practice Location

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