Provider Demographics
NPI:1508518770
Name:BARSOOM, ELIZABETH AMIRA (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMIRA
Last Name:BARSOOM
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 W CENTENNIAL DR UNIT L
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8550
Mailing Address - Country:US
Mailing Address - Phone:402-213-2031
Mailing Address - Fax:
Practice Address - Street 1:3601 S LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3001
Practice Address - Country:US
Practice Address - Phone:303-761-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00026152255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer