Provider Demographics
NPI:1437286234
Name:FUENTES, JESSICA (PT, DPT, PCS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAIN ST
Mailing Address - Street 2:STE. 10
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1864
Mailing Address - Country:US
Mailing Address - Phone:303-887-4466
Mailing Address - Fax:303-957-1955
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:STE. 10
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1864
Practice Address - Country:US
Practice Address - Phone:303-887-4466
Practice Address - Fax:303-957-1955
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48889733Medicaid