Provider Demographics
NPI:1922255173
Name:FORESMAN, EDWARD DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:DAVID
Last Name:FORESMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 S GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1416
Mailing Address - Country:US
Mailing Address - Phone:303-475-5102
Mailing Address - Fax:
Practice Address - Street 1:600 S CHERRY ST STE 145
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1703
Practice Address - Country:US
Practice Address - Phone:303-475-5102
Practice Address - Fax:844-689-1158
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10139225100000X
COPTL-10139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist