Provider Demographics
NPI:1871663229
Name:MONTEFERRANTE, THERESA LOUISE (PT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LOUISE
Last Name:MONTEFERRANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:LOUISE
Other - Last Name:MATTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:#415
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-745-7997
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:SUITE I
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-841-5594
Practice Address - Fax:303-841-8890
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804861Medicare ID - Type Unspecified
COP75302Medicare UPIN