Healthcare Provider Details

I. General information

NPI: 1992810683
Provider Name (Legal Business Name): REBECCA FETCHEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD STE 640
DENVER CO
80246-1253
US

IV. Provider business mailing address

20528 MARCH DR
DENVER CO
80249-8596
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-4450
  • Fax: 303-320-6668
Mailing address:
  • Phone: 303-320-4450
  • Fax: 303-320-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: