Provider Demographics
NPI:1114059177
Name:ACEVEDO, ISABEL (PT)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:ACEVEDO
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 1:3880 GRANT AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8433
Mailing Address - Country:US
Mailing Address - Phone:970-663-7780
Mailing Address - Fax:
Practice Address - Street 1:3880 GRANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8433
Practice Address - Country:US
Practice Address - Phone:970-663-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010200225100000X
COPTL.0015665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633203OtherBCBS PIC
IL1633794OtherBLUE CROSS PROVIDER
IL01633203OtherBCBS PIC
ILK25538Medicare PIN
IL213992Medicare PIN