Provider Demographics
NPI:1710913041
Name:CORREIA, EDWARD JR (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CORREIA
Suffix:JR
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 1:6900 E 47TH AVENUE DR
Mailing Address - Street 2:STE. 150
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 E 47TH AVENUE DR
Practice Address - Street 2:STE. 150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3463
Practice Address - Country:US
Practice Address - Phone:303-388-7719
Practice Address - Fax:303-388-8072
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist