Provider Demographics
NPI:1821342064
Name:BABASICK, DONNA (PTA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BABASICK
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 1:3700 E JEWELL AVE
Mailing Address - Street 2:#413
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3759
Mailing Address - Country:US
Mailing Address - Phone:720-253-6839
Mailing Address - Fax:
Practice Address - Street 1:3700 E JEWELL AVE
Practice Address - Street 2:#413
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3759
Practice Address - Country:US
Practice Address - Phone:720-253-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012980225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0012980OtherMEDICARE