MEDICARE: MR. ERIC R. DEINES PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8569	CO

General Provider Information

NPI Number	:	1104800713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC R. DEINES PT, DPT

Provider Business Mailing Address
First Line	:	8033 S RACE WAY
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-3217
Country	:	US
Telephone Number	:	303-909-9393
Fax Number	:	303-738-5544

Provider Business Practice Location Address
First Line	:	8033 S RACE WAY
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-3217
Country	:	US
Telephone Number	:	303-909-9393
Fax Number	:	303-738-5544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	06/13/2010

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