Healthcare Provider Details

I. General information

NPI: 1952699225
Provider Name (Legal Business Name): STEPHEN CZERNIAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HALE PKWY STE 550
DENVER CO
80220
US

IV. Provider business mailing address

4700 HALE PKWY STE 550
DENVER CO
80220-4053
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-6600
  • Fax: 303-321-8814
Mailing address:
  • Phone: 303-321-6600
  • Fax: 303-321-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-018565
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015699
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: