Provider Demographics
NPI:1093094799
Name:CIMINO, DAVID JAMES (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:CIMINO
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:PO BOX 4828
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-4828
Mailing Address - Country:US
Mailing Address - Phone:970-569-3883
Mailing Address - Fax:970-569-3884
Practice Address - Street 1:1140 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE B208
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8163
Practice Address - Country:US
Practice Address - Phone:970-569-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist