Provider Demographics
NPI:1558955872
Name:ADWAN, RAKAN NASSIM (PTA)
Entity Type:Individual
Prefix:
First Name:RAKAN
Middle Name:NASSIM
Last Name:ADWAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 W 54TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3651
Mailing Address - Country:US
Mailing Address - Phone:580-491-2933
Mailing Address - Fax:
Practice Address - Street 1:401 W HAMPDEN PL STE 10
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2471
Practice Address - Country:US
Practice Address - Phone:303-781-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant