Provider Demographics
NPI:1841414299
Name:TARVESTAD, DOROTHY L (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:TARVESTAD
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 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1904
Mailing Address - Country:US
Mailing Address - Phone:303-584-8231
Mailing Address - Fax:303-584-8141
Practice Address - Street 1:125 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2546
Practice Address - Country:US
Practice Address - Phone:303-788-9200
Practice Address - Fax:303-788-9265
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066615OtherMEDICARE GROUP NUMBER