Provider Demographics
NPI:1073757035
Name:PLAATJES, MARK (RPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PLAATJES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 PEARL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3811
Mailing Address - Country:US
Mailing Address - Phone:303-247-0687
Mailing Address - Fax:303-545-9369
Practice Address - Street 1:2775 PEARL ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3811
Practice Address - Country:US
Practice Address - Phone:303-247-0687
Practice Address - Fax:303-545-9369
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35802251S0007X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist