Provider Demographics
NPI:1447248307
Name:WEAVER-CROOKHAM, JENNIFER A (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:WEAVER-CROOKHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 200-A, DEPT 914
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8000
Mailing Address - Fax:303-584-8141
Practice Address - Street 1:720 S COLORADO BLVD
Practice Address - Street 2:SUITE 200-A, DEPT 914
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1912
Practice Address - Country:US
Practice Address - Phone:303-584-8288
Practice Address - Fax:866-210-2804
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066615OtherMEDICARE GROUP #