Provider Demographics
NPI:1376905562
Name:THRELKELD, MONA (PT)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:THRELKELD
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 1:750 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-1805
Mailing Address - Country:US
Mailing Address - Phone:970-323-5504
Mailing Address - Fax:
Practice Address - Street 1:708 1250 RD
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-9109
Practice Address - Country:US
Practice Address - Phone:970-210-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL 0008848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist