Provider Demographics
NPI:1942243159
Name:FAKTOR, TAMARA S (PT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:FAKTOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9830 I-70 FRONTAGE ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1724
Mailing Address - Country:US
Mailing Address - Phone:303-467-4100
Mailing Address - Fax:303-420-0836
Practice Address - Street 1:9830 I-70 FRONTAGE ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1724
Practice Address - Country:US
Practice Address - Phone:303-467-4100
Practice Address - Fax:303-420-0836
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18834531Medicaid
CO18834531Medicaid