1740290220 NPI number — DONNA S TEGETHOFF P.T.

Table of content: DONNA S TEGETHOFF P.T. (NPI 1740290220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740290220 NPI number — DONNA S TEGETHOFF P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEGETHOFF
Provider First Name:
DONNA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1740290220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2032 LOWE ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-5741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-223-6339
Provider Business Mailing Address Fax Number:
970-223-6382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 E 130TH AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80241-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-213-3087
Provider Business Practice Location Address Fax Number:
303-452-3087
Provider Enumeration Date:
08/08/2006

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:  3125 , 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)





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