MEDICARE: JOHNA IANNITTO 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	PTL0017527	CO
2	2251X0800X	Orthopedic Physical Therapist	PTL0017527	CO

General Provider Information

NPI Number	:	1316531007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNA IANNITTO DPT

Provider Business Mailing Address
First Line	:	13659 E 104TH AVE UNIT 300
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9402
Country	:	US
Telephone Number	:	720-506-5340
Fax Number	:

Provider Business Practice Location Address
First Line	:	13659 E 104TH AVE UNIT 300
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9402
Country	:	US
Telephone Number	:	720-506-5340
Fax Number	:

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

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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Directions to “ JOHNA IANNITTO DPT” Practice Location

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