Provider Demographics
NPI:1811221062
Name:DESBOIS, JENNIFER T (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:DESBOIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19131 E COTTONWOOD DR
Mailing Address - Street 2:1332
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8669
Mailing Address - Country:US
Mailing Address - Phone:303-704-7468
Mailing Address - Fax:
Practice Address - Street 1:9995 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5341
Practice Address - Country:US
Practice Address - Phone:303-792-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC477678Medicare UPIN