Healthcare Provider Details

I. General information

NPI: 1942828744
Provider Name (Legal Business Name): MARK IAN LOMBARDO JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 E JEWELL AVE
AURORA CO
80012-5689
US

IV. Provider business mailing address

14400 E JEWELL AVE
AURORA CO
80012-5689
US

V. Phone/Fax

Practice location:
  • Phone: 720-989-9506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0017012
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: