Healthcare Provider Details

I. General information

NPI: 1720334295
Provider Name (Legal Business Name): ALISSA JEAN POWERS PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA JEAN KRAJECKI PT, DPT, ATC

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax:
Mailing address:
  • Phone: 970-624-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0001073
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0011823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: