1487984548 NPI number — JON TIMOTHY NOTEBOOM PT

Table of content: JON TIMOTHY NOTEBOOM PT (NPI 1487984548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487984548 NPI number — JON TIMOTHY NOTEBOOM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOTEBOOM
Provider First Name:
JON
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOTEBOOM
Provider Other First Name:
TIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487984548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 REGIS BLVD
Provider Second Line Business Mailing Address:
SCHOOL OF PHYSICAL THERAPY, G-4
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80221-1154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-458-4268
Provider Business Mailing Address Fax Number:
303-964-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 REGIS BLVD
Provider Second Line Business Practice Location Address:
SCHOOL OF PHYSICAL THERAPY, G-4
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80221-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-458-4268
Provider Business Practice Location Address Fax Number:
303-964-5474
Provider Enumeration Date:
01/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3407 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 3407 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)