Provider Demographics
NPI:1407571219
Name:NUNES, GEORDAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GEORDAN
Middle Name:
Last Name:NUNES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 VANCE ST APT 1132
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-7011
Mailing Address - Country:US
Mailing Address - Phone:860-989-1256
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1714
Practice Address - Country:US
Practice Address - Phone:860-989-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist