Provider Demographics
NPI:1063852226
Name:OTTENBREIT, DORNA DEAN (PT)
Entity Type:Individual
Prefix:
First Name:DORNA
Middle Name:DEAN
Last Name:OTTENBREIT
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 1:10276 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-6804
Mailing Address - Country:US
Mailing Address - Phone:303-906-2288
Mailing Address - Fax:303-841-8686
Practice Address - Street 1:10276 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-6804
Practice Address - Country:US
Practice Address - Phone:303-906-2288
Practice Address - Fax:303-841-8686
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist