Provider Demographics
NPI:1750300489
Name:RADER, RICARDO DAVID (PT)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:DAVID
Last Name:RADER
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 1:1020 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6002
Mailing Address - Country:US
Mailing Address - Phone:720-723-5129
Mailing Address - Fax:
Practice Address - Street 1:1020 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6002
Practice Address - Country:US
Practice Address - Phone:720-723-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802604Medicare ID - Type Unspecified