Provider Demographics
NPI:1609219914
Name:FANTAUZZO, STEPHEN J (CO)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:FANTAUZZO
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 STERLING HILL CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7605
Mailing Address - Country:US
Mailing Address - Phone:303-907-9686
Mailing Address - Fax:
Practice Address - Street 1:7100 BROADWAY
Practice Address - Street 2:SUITE 2E
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2915
Practice Address - Country:US
Practice Address - Phone:303-316-2615
Practice Address - Fax:303-331-9019
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist