Provider Demographics
NPI:1891745998
Name:NISHIMOTO, TERRI (PT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:NISHIMOTO
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 1:1601 EAST 19TH AVE
Mailing Address - Street 2:SUITE 5500
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1291
Mailing Address - Country:US
Mailing Address - Phone:720-402-3801
Mailing Address - Fax:720-402-3820
Practice Address - Street 1:1601 EAST 19TH AVE
Practice Address - Street 2:SUITE 5500
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1291
Practice Address - Country:US
Practice Address - Phone:720-402-3801
Practice Address - Fax:720-402-3820
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 2031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CON0523Medicare PIN