Provider Demographics
NPI:1265866685
Name:BOON, MARTHA TINSLEY (DPT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:TINSLEY
Last Name:BOON
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 1:7901 S ADAMS WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3601
Mailing Address - Country:US
Mailing Address - Phone:303-694-3604
Mailing Address - Fax:303-694-3604
Practice Address - Street 1:1319 W BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9308
Practice Address - Country:US
Practice Address - Phone:303-655-8747
Practice Address - Fax:303-926-0184
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist