Provider Demographics
NPI:1235518135
Name:AMUCHASTEGUI, ELIZABETH ANDREA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANDREA
Last Name:AMUCHASTEGUI
Suffix:
Gender:F
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 1:2695 NORTHPARK DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3177
Mailing Address - Country:US
Mailing Address - Phone:303-926-1796
Mailing Address - Fax:
Practice Address - Street 1:2695 NORTHPARK DR
Practice Address - Street 2:SUITE #102
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3177
Practice Address - Country:US
Practice Address - Phone:303-926-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist