1073059986 NPI number — COURTNEY LEIGH GALVAN ATC

Table of content: COURTNEY LEIGH GALVAN ATC (NPI 1073059986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073059986 NPI number — COURTNEY LEIGH GALVAN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVAN
Provider First Name:
COURTNEY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTILLO
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073059986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16674 E LOUISIANA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80017-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-220-9919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 E 47TH AVENUE DR STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80216-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-920-1200
Provider Business Practice Location Address Fax Number:
303-920-1281
Provider Enumeration Date:
01/16/2017

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: 390200000X , with the licence number:  AT.0001558 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: AT.0001558 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22 . This is a "ATHLETIC TRAINER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".