Provider Demographics
NPI:1427573559
Name:JOHNSON, BEATRIZ ALEJANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ALEJANDRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CIRQUE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3280
Mailing Address - Country:US
Mailing Address - Phone:956-451-8671
Mailing Address - Fax:
Practice Address - Street 1:2350 LIMON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7622
Practice Address - Country:US
Practice Address - Phone:970-204-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1427573559Medicaid
CO9000159982Medicaid