Healthcare Provider Details

I. General information

NPI: 1508274036
Provider Name (Legal Business Name): ANDREA FETZER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S COLORADO BLVD SUITE 1-4500
DENVER CO
80222-7900
US

IV. Provider business mailing address

1995 S DOWNING ST
DENVER CO
80210-4124
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: