Provider Demographics
NPI:1689754087
Name:RAKITA, DAVID N (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:RAKITA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RIVERGATE UNIT 97
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7490
Mailing Address - Country:US
Mailing Address - Phone:970-259-0574
Mailing Address - Fax:970-259-0576
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:SUITE 97
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-0574
Practice Address - Fax:970-259-0576
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73604577Medicaid
CO73604577Medicaid