Healthcare Provider Details

I. General information

NPI: 1790772630
Provider Name (Legal Business Name): MITZI L HARRISON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MITZI L RODRIGUEZ PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 PEARL ST STE 300
BOULDER CO
80302-4673
US

IV. Provider business mailing address

2299 PEARL ST STE 300
BOULDER CO
80302-4673
US

V. Phone/Fax

Practice location:
  • Phone: 720-845-0001
  • Fax: 720-204-1748
Mailing address:
  • Phone: 720-845-0001
  • Fax: 720-204-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13219
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number13219
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: