Provider Demographics
NPI:1609071950
Name:WIDNER-MASSEY, EVELYN J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:J
Last Name:WIDNER-MASSEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18908 BRIARGATE LN APT 1A
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 S STEELE ST STE 550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2832
Practice Address - Country:US
Practice Address - Phone:303-393-6533
Practice Address - Fax:303-393-7846
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist