Provider Demographics
NPI:1437405644
Name:WINTERSIECK, MARY ELLINGTON POMEROY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLINGTON POMEROY
Last Name:WINTERSIECK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ELLINGTON
Other - Last Name:POMEROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:9351 GRANT ST STE 430
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4365
Mailing Address - Country:US
Mailing Address - Phone:303-280-1211
Mailing Address - Fax:
Practice Address - Street 1:9351 GRANT ST STE 430
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4365
Practice Address - Country:US
Practice Address - Phone:303-280-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0011783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist