Provider Demographics
NPI:1043256332
Name:GIFFORD, JANICE K (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:K
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 N ANNABELLE CT
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2096
Mailing Address - Country:US
Mailing Address - Phone:970-261-1231
Mailing Address - Fax:
Practice Address - Street 1:461 N ANNABELLE CT
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2096
Practice Address - Country:US
Practice Address - Phone:970-261-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840999425OtherTAX ID
COP00200035OtherMEDICARE RAILROAD
CO840999425008OtherRMHMO
COC533168Medicare PIN