Provider Demographics
NPI:1710403647
Name:PIETRO, ERIN (PTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PIETRO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:PIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4830 VAN GORDON ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2116
Mailing Address - Country:US
Mailing Address - Phone:720-379-8802
Mailing Address - Fax:
Practice Address - Street 1:7481 KNOX PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4818
Practice Address - Country:US
Practice Address - Phone:303-427-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014083225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant