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General NPI Number Information
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NPI Number | 1104276344
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Entity Type | Individual
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Provider Name | MARISSA KORTH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/19/2016
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 3801 E FLORIDA AVE STE 917
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City | DENVER
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State | CO
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Zip | 80210-2549
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Country | US
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Telephone | 815-298-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 OURAY CT
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City | FORT COLLINS
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State | CO
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Zip | 80525-1893
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0014055
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License Number State | CO
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