Provider Demographics
NPI:1467011098
Name:MATHIS, JITTIARPA NAIMEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JITTIARPA
Middle Name:NAIMEE
Last Name:MATHIS
Suffix:
Gender:F
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 1:6260 W 5TH PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1814
Mailing Address - Country:US
Mailing Address - Phone:360-259-5267
Mailing Address - Fax:
Practice Address - Street 1:4700 HALE PKWY STE 540
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4053
Practice Address - Country:US
Practice Address - Phone:303-370-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist