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General NPI Number Information
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NPI Number | 1609382696
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Entity Type | Individual
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Provider Name | THOMAS STOTT
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Gender | Male
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 13606 XAVIER LN STE C
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City | BROOMFIELD
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State | CO
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Zip | 80023-3604
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Country | US
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Telephone | 303-404-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 13606 XAVIER LN STE C
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City | BROOMFIELD
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State | CO
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Zip | 80023-3604
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PTA.0014052
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License Number State | CO
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