Healthcare Provider Details

I. General information

NPI: 1568923555
Provider Name (Legal Business Name): ELIZABETH PLIAKOS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12567 W CEDAR DR STE 120
LAKEWOOD CO
80228-2039
US

IV. Provider business mailing address

7628 W 54TH AVE APT 202
ARVADA CO
80002-4502
US

V. Phone/Fax

Practice location:
  • Phone: 309-428-9160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014420
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: