Healthcare Provider Details

I. General information

NPI: 1386612893
Provider Name (Legal Business Name): PETORA MANETTO SPRATT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5278 S ESPANA CIR
CENTENNIAL CO
80015-3704
US

IV. Provider business mailing address

5278 S ESPANA CIR
CENTENNIAL CO
80015-3704
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-8318
  • Fax: 303-627-4874
Mailing address:
  • Phone: 303-912-8318
  • Fax: 303-627-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2318
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: