Healthcare Provider Details

I. General information

NPI: 1003873613
Provider Name (Legal Business Name): JENNIFER LYNN EYRICH PTA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 DELGANY ST UNIT 1448
DENVER CO
80202-1757
US

IV. Provider business mailing address

2121 DELGANY ST UNIT 1448
DENVER CO
80202-1757
US

V. Phone/Fax

Practice location:
  • Phone: 202-277-0284
  • Fax: 202-223-1738
Mailing address:
  • Phone: 202-277-0284
  • Fax: 202-223-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: