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General NPI Number Information
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NPI Number | 1740090232
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Entity Type | Individual
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Provider Name | ETHAN DVORAK
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Gender | Male
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 3401 S LAFAYETTE ST
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2926
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Country | US
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Telephone | 720-838-2219
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 S PEARL ST UNIT B
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2884
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Country | US
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Telephone | 970-481-1876
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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 | PTL.0020326
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License Number State | CO
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