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General NPI Number Information
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NPI Number | 1285561324
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Entity Type | Individual
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Provider Name | ELISE WIDMAN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 1411 S POTOMAC ST STE 400
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City | AURORA
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State | CO
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Zip | 80012-4540
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Country | US
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Telephone | 303-481-0620
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Fax |
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Provider Business Mailing Address
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Address Line | 11124 CRESTMONT DR
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City | RALEIGH
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State | NC
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Zip | 27613-5910
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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 | P19214
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License Number State | NC
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