Provider Demographics
NPI:1184841793
Name:STAMM, ANDREA TAPIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:TAPIA
Last Name:STAMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4811 WHITE ROCK CIR APT C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6713
Mailing Address - Country:US
Mailing Address - Phone:303-819-4617
Mailing Address - Fax:720-304-3523
Practice Address - Street 1:75 MANHATTAN DR
Practice Address - Street 2:STE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4254
Practice Address - Country:US
Practice Address - Phone:303-819-4617
Practice Address - Fax:720-304-3523
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7006261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy