Healthcare Provider Details

I. General information

NPI: 1568605897
Provider Name (Legal Business Name): JENNIFER ELIZABETH DAVIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 13TH AVE
LAKEWOOD CO
80626
US

IV. Provider business mailing address

7815 ALLISON WAY #105
ARVADA CO
80005
US

V. Phone/Fax

Practice location:
  • Phone: 303-770-4682
  • Fax:
Mailing address:
  • Phone: 970-539-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: