Provider Demographics
NPI:1497419055
Name:PERSSON, PER MAGNUS (PT)
Entity Type:Individual
Prefix:
First Name:PER
Middle Name:MAGNUS
Last Name:PERSSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 S PARKER RD STE 930
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2948
Mailing Address - Country:US
Mailing Address - Phone:509-432-1705
Mailing Address - Fax:
Practice Address - Street 1:3025 S PARKER RD STE 930
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80014-2948
Practice Address - Country:US
Practice Address - Phone:509-432-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist