Provider Demographics
NPI:1023186137
Name:VAN DUURSEN, STEFANUS JH (PT)
Entity Type:Individual
Prefix:
First Name:STEFANUS
Middle Name:JH
Last Name:VAN DUURSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S COLORADO BLVD STE A620
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3375
Mailing Address - Country:US
Mailing Address - Phone:303-691-3733
Mailing Address - Fax:303-691-1142
Practice Address - Street 1:1385 S COLORADO BLVD STE A620
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3375
Practice Address - Country:US
Practice Address - Phone:303-691-3733
Practice Address - Fax:303-691-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09924566Medicaid
CO09924566Medicaid
COC810325Medicare PIN
1023186137Medicare UPIN