Provider Demographics
NPI:1275649915
Name:WESTPHAL, DESIRAE N (DPT)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:N
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DESIRAE
Other - Middle Name:N
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1020 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4016
Mailing Address - Country:US
Mailing Address - Phone:970-493-8727
Mailing Address - Fax:970-493-8739
Practice Address - Street 1:1020 LUKE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4016
Practice Address - Country:US
Practice Address - Phone:970-493-8727
Practice Address - Fax:970-493-8739
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804576Medicare ID - Type Unspecified