Provider Demographics
NPI:1922487297
Name:STURGEON, WILLIAM (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:STURGEON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 GRANT ST
Mailing Address - Street 2:SUITE #430
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4358
Mailing Address - Country:US
Mailing Address - Phone:303-280-1211
Mailing Address - Fax:303-280-2232
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:SUITE #430
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4358
Practice Address - Country:US
Practice Address - Phone:303-280-1211
Practice Address - Fax:303-280-2232
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013595225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11609354Medicaid