Provider Demographics
NPI:1275633323
Name:MITTLEIDER, DENNIS MARK (RPT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MARK
Last Name:MITTLEIDER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:497 GREY SQUIRREL WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-8766
Mailing Address - Country:US
Mailing Address - Phone:303-663-1259
Mailing Address - Fax:303-688-5896
Practice Address - Street 1:497 GREY SQUIRREL WAY
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-8766
Practice Address - Country:US
Practice Address - Phone:303-663-1259
Practice Address - Fax:303-688-5896
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-4473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist