Healthcare Provider Details

I. General information

NPI: 1003589243
Provider Name (Legal Business Name): EMMA JANSSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 405
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

1760 E KEN PRATT BLVD STE 405
LONGMONT CO
80504-5311
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-5400
  • Fax: 720-718-5987
Mailing address:
  • Phone: 720-718-5400
  • Fax: 720-718-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0017894
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: