Provider Demographics
NPI:1922155134
Name:BEBENDORF, KARL RONALD (PT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:RONALD
Last Name:BEBENDORF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2626 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1412
Mailing Address - Country:US
Mailing Address - Phone:038-323-7003
Mailing Address - Fax:303-832-3712
Practice Address - Street 1:2626 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1412
Practice Address - Country:US
Practice Address - Phone:038-323-7003
Practice Address - Fax:303-832-3712
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87902251X0800X
COPTL.8790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810633Medicare PIN