Provider Demographics
NPI:1235426321
Name:VANAS, DAVID JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:VANAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 16TH ST
Mailing Address - Street 2:UNIT 212
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5184
Mailing Address - Country:US
Mailing Address - Phone:440-463-9267
Mailing Address - Fax:
Practice Address - Street 1:802 19TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7612
Practice Address - Country:US
Practice Address - Phone:440-463-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL-11337OtherLICENSE NUMBER