Provider Demographics
NPI:1578544706
Name:MUNDT, ERIC (MSPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MUNDT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 E ORCHARD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1725
Mailing Address - Country:US
Mailing Address - Phone:303-770-1305
Mailing Address - Fax:303-770-1306
Practice Address - Street 1:7180 E ORCHARD RD STE 110
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1725
Practice Address - Country:US
Practice Address - Phone:303-770-1305
Practice Address - Fax:303-770-1306
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7875225100000X
WY929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist