1962940825 NPI number — MRS. ALICE JEANETTE RADIC PTA

Table of content: MRS. ALICE JEANETTE RADIC PTA (NPI 1962940825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962940825 NPI number — MRS. ALICE JEANETTE RADIC PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADIC
Provider First Name:
ALICE
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1962940825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13123 E16TH AVE BOX 385
Provider Second Line Business Mailing Address:
CHILDRENS HOSPITAL CO PHYSICAL THERAPY
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-777-1234
Provider Business Mailing Address Fax Number:
720-777-7297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13123 E 16TH AVE
Provider Second Line Business Practice Location Address:
BOX 385
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-777-1234
Provider Business Practice Location Address Fax Number:
720-777-7297
Provider Enumeration Date:
02/10/2017

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: 225200000X , with the licence number:  PTA 0013282 , 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)





Copyright © 2007-2025 www.npivalidator.com