Healthcare Provider Details

I. General information

NPI: 1629801345
Provider Name (Legal Business Name): MARISSA WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S PEARL ST STE 101
DENVER CO
80210-2645
US

IV. Provider business mailing address

7340 S ALTON WAY STE 11-D
CENTENNIAL CO
80112-2323
US

V. Phone/Fax

Practice location:
  • Phone: 720-873-6866
  • Fax: 303-871-0830
Mailing address:
  • Phone: 720-493-1181
  • Fax: 720-493-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: