Provider Demographics
NPI:1407343429
Name:VENTER, JOHANN (PT)
Entity Type:Individual
Prefix:
First Name:JOHANN
Middle Name:
Last Name:VENTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 S KINGSTON CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5733
Mailing Address - Country:US
Mailing Address - Phone:513-384-9760
Mailing Address - Fax:
Practice Address - Street 1:6086 S KINGSTON CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5733
Practice Address - Country:US
Practice Address - Phone:513-384-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL000000015416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17-080-0492OtherDRIVER LICENSE