Healthcare Provider Details

I. General information

NPI: 1649755398
Provider Name (Legal Business Name): JESUS URZUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 GRANT AVE STE 100
LOVELAND CO
80538-8433
US

IV. Provider business mailing address

3880 GRANT AVE STE 100
LOVELAND CO
80538-8433
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-7780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015920
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: