Provider Demographics
NPI:1164010336
Name:LEAVITT, ANNIE ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 S ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4839
Mailing Address - Country:US
Mailing Address - Phone:949-973-5308
Mailing Address - Fax:
Practice Address - Street 1:251 VIOLET ST STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6724
Practice Address - Country:US
Practice Address - Phone:303-279-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL00174442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic