Provider Demographics
NPI:1770241390
Name:IMBUSCH, DENISE LEA (PTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LEA
Last Name:IMBUSCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 S HANNIBAL ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2502
Mailing Address - Country:US
Mailing Address - Phone:303-781-4290
Mailing Address - Fax:
Practice Address - Street 1:3102 S PARKER RD STE A15
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3108
Practice Address - Country:US
Practice Address - Phone:303-338-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015111225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant