Healthcare Provider Details

I. General information

NPI: 1518153642
Provider Name (Legal Business Name): WAYNE PETER VOTH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-2517
US

IV. Provider business mailing address

1000 S COLUMBIA RD
GRAND FORKS ND
58201-4032
US

V. Phone/Fax

Practice location:
  • Phone: 719-629-6796
  • Fax: 888-505-3617
Mailing address:
  • Phone: 701-780-5000
  • Fax: 701-780-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1466
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: