Provider Demographics
NPI:1295460657
Name:GINSBURG, KEERA SHOSHANNA (PTA)
Entity Type:Individual
Prefix:
First Name:KEERA
Middle Name:SHOSHANNA
Last Name:GINSBURG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ALBION ST UNIT 1428
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4476
Mailing Address - Country:US
Mailing Address - Phone:301-758-8453
Mailing Address - Fax:
Practice Address - Street 1:12510 E ILIFF AVE STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6377
Practice Address - Country:US
Practice Address - Phone:303-862-8853
Practice Address - Fax:720-379-5827
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0015198225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant