Provider Demographics
NPI:1972799229
Name:BOURNE, JENNIFER LOUISE (PT, DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:BOURNE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 LAGAE RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108
Mailing Address - Country:US
Mailing Address - Phone:303-663-5552
Mailing Address - Fax:303-663-5554
Practice Address - Street 1:7280 LAGAE RD
Practice Address - Street 2:UNIT F
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108
Practice Address - Country:US
Practice Address - Phone:720-733-3655
Practice Address - Fax:720-733-3656
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9754OtherSTATE LICENSE