MEDICARE: ERIN MUMBY PTA

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	225200000X	Physical Therapy Assistant	0014084	CO

General Provider Information

NPI Number	:	1942867775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MUMBY PTA

Provider Business Mailing Address
First Line	:	1662 S DEFRAME ST UNIT C1
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-6018
Country	:	US
Telephone Number	:	970-623-9523
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 N LINCOLN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2710
Country	:	US
Telephone Number	:	303-482-1540
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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