Provider Demographics
NPI:1275610933
Name:AMUNDSON, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-0848
Mailing Address - Country:US
Mailing Address - Phone:303-514-8643
Mailing Address - Fax:
Practice Address - Street 1:28577 BUFFALO PARK RD STE 205
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:720-900-3801
Practice Address - Fax:720-835-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9388OtherLICENSE#