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General NPI Number Information
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NPI Number | 1205233756
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Entity Type | Individual
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Provider Name | JENNIFER MONDELLO PT,DPT, NCS
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Gender | Female
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Dates
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Enumeration Date | 11/28/2014
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 811 BRICKYARD CIR
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City | GOLDEN
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State | CO
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Zip | 80403-8058
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Country | US
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Telephone | 541-951-8170
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Fax |
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Provider Business Mailing Address
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Address Line | 18995 W 62ND AVE
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City | GOLDEN
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State | CO
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Zip | 80403-1081
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Country | US
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Telephone | 303-884-6803
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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 | 12677
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License Number State | CO
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