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General NPI Number Information
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NPI Number | 1417284308
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Entity Type | Individual
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Provider Name | SUSAN DEANNE KOTELNICKI PTA
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Gender | Female
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 700 COLORADO BLVD # 318
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City | DENVER
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State | CO
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Zip | 80206-4084
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Country | US
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Telephone | 303-339-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 125 W TRIUMPH ST
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City | EBENSBURG
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State | PA
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Zip | 15931-1938
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Country | US
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Telephone | 814-472-5907
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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 | TEI000469
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License Number State | PA
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