Provider Demographics
NPI:1821862228
Name:GOLES, THEODORE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:GOLES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S CHEROKEE ST APT 2429
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2066
Mailing Address - Country:US
Mailing Address - Phone:210-569-9579
Mailing Address - Fax:
Practice Address - Street 1:205 W HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2401
Practice Address - Country:US
Practice Address - Phone:303-789-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist