Healthcare Provider Details

I. General information

NPI: 1578544706
Provider Name (Legal Business Name): ERIC MUNDT MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 E ORCHARD RD STE 110
CENTENNIAL CO
80111-1725
US

IV. Provider business mailing address

7180 E ORCHARD RD STE 110
CENTENNIAL CO
80111-1725
US

V. Phone/Fax

Practice location:
  • Phone: 303-770-1305
  • Fax: 303-770-1306
Mailing address:
  • Phone: 303-770-1305
  • Fax: 303-770-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7875
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number929
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: