Healthcare Provider Details

I. General information

NPI: 1790622462
Provider Name (Legal Business Name): VACLAV BEDNAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 WADSWORTH BLVD
WHEAT RIDGE CO
80033-4615
US

IV. Provider business mailing address

3916 WADSWORTH BLVD
WHEAT RIDGE CO
80033-4615
US

V. Phone/Fax

Practice location:
  • Phone: 720-805-2303
  • Fax: 720-573-6704
Mailing address:
  • Phone: 720-805-2303
  • Fax: 720-573-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407680
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055022T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: