Provider Demographics
NPI:1346469236
Name:SIROTNIAK, ANN CLARE (PT)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:CLARE
Last Name:SIROTNIAK
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 2552
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-2552
Mailing Address - Country:US
Mailing Address - Phone:303-823-6433
Mailing Address - Fax:
Practice Address - Street 1:WARDENBURG HEALTH CTR
Practice Address - Street 2:CAMPUS BOX 119
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0119
Practice Address - Country:US
Practice Address - Phone:303-492-6280
Practice Address - Fax:303-492-1248
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist