Healthcare Provider Details

I. General information

NPI: 1992914428
Provider Name (Legal Business Name): MAURA LEE JANE TIERNEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAURA TIERNEY PT, DPT

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 GINNALA DR
LOVELAND CO
80538-2701
US

IV. Provider business mailing address

2203 CUTTING HORSE DR # 2011
FORT COLLINS CO
80525-2075
US

V. Phone/Fax

Practice location:
  • Phone: 303-222-4312
  • Fax:
Mailing address:
  • Phone: 609-202-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061111T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: