Provider Demographics
NPI:1629576509
Name:DENNISTON, ROBERT FREDRICK III (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FREDRICK
Last Name:DENNISTON
Suffix:III
Gender:M
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 1:1266 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1525
Mailing Address - Country:US
Mailing Address - Phone:262-402-4478
Mailing Address - Fax:
Practice Address - Street 1:3989 E ARAPAHOE RD STE 216
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2077
Practice Address - Country:US
Practice Address - Phone:720-644-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist