Provider Demographics
NPI:1376912238
Name:MIRZOYEV, TEYMUR (DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:TEYMUR
Middle Name:
Last Name:MIRZOYEV
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N US HIGHWAY 287 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8953
Mailing Address - Country:US
Mailing Address - Phone:718-839-4542
Mailing Address - Fax:
Practice Address - Street 1:297 N US HIGHWAY 287 STE 105
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8953
Practice Address - Country:US
Practice Address - Phone:718-839-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038707-1225100000X
CO152952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist