Healthcare Provider Details

I. General information

NPI: 1972256782
Provider Name (Legal Business Name): ANDREW V MISIOROWSKI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 PEARL PKWY STE 300
BOULDER CO
80301-3080
US

IV. Provider business mailing address

4740 PEARL PKWY STE 200
BOULDER CO
80301-3080
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-2730
  • Fax: 303-449-5821
Mailing address:
  • Phone: 303-449-2730
  • Fax: 303-449-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020921
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61543218
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25962
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: