Healthcare Provider Details

I. General information

NPI: 1659513448
Provider Name (Legal Business Name): AMY JEPSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 92ND AVE
FEDERAL HEIGHTS CO
80260-5811
US

IV. Provider business mailing address

2800 W 92ND AVE
FEDERAL HEIGHTS CO
80260-5811
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-2414
  • Fax: 303-427-5719
Mailing address:
  • Phone: 303-427-2414
  • Fax: 303-427-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5336
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: