Provider Demographics
NPI:1629080890
Name:VENTZKE, SUSANNE CLAUDIA (MSPT)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:CLAUDIA
Last Name:VENTZKE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 EGBERT STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601
Mailing Address - Country:US
Mailing Address - Phone:303-637-1039
Mailing Address - Fax:303-637-1033
Practice Address - Street 1:1850 E EGBERT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2404
Practice Address - Country:US
Practice Address - Phone:303-637-1039
Practice Address - Fax:303-637-1033
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-6600Medicare Oscar/Certification