Provider Demographics
NPI:1851591234
Name:JERZY SREBNIAK
Entity Type:Organization
Organization Name:JERZY SREBNIAK
Other - Org Name:DENVER REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERZY
Authorized Official - Middle Name:
Authorized Official - Last Name:SREBNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-333-0267
Mailing Address - Street 1:6825 E TENNESSEE AVE
Mailing Address - Street 2:SUITE # 325
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1628
Mailing Address - Country:US
Mailing Address - Phone:303-333-0267
Mailing Address - Fax:303-333-1038
Practice Address - Street 1:6825 E TENNESSEE AVE
Practice Address - Street 2:SUITE # 325
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1628
Practice Address - Country:US
Practice Address - Phone:303-333-0267
Practice Address - Fax:303-333-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54222036Medicaid
=========OtherTAX ID