Healthcare Provider Details

I. General information

NPI: 1629576509
Provider Name (Legal Business Name): ROBERT FREDRICK DENNISTON III PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 E ARAPAHOE RD STE 216
CENTENNIAL CO
80122-2077
US

IV. Provider business mailing address

1266 S LOGAN ST
DENVER CO
80210-1525
US

V. Phone/Fax

Practice location:
  • Phone: 720-644-0181
  • Fax:
Mailing address:
  • Phone: 262-402-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0015388
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: