Provider Demographics
NPI:1578681136
Name:ROINESTAD, THOMAS FREDERICK (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FREDERICK
Last Name:ROINESTAD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 FLATIRON MTN RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537
Mailing Address - Country:US
Mailing Address - Phone:970-667-0262
Mailing Address - Fax:970-667-0262
Practice Address - Street 1:11012 FLATIRON MTN RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-667-0262
Practice Address - Fax:970-667-0262
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4960171R00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50833Medicare ID - Type UnspecifiedMEDICARE