Provider Demographics
NPI:1104094440
Name:MCINTIRE, VEDA L (PT, DPT, PRPC)
Entity type:Individual
Prefix:
First Name:VEDA
Middle Name:L
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13606 XAVIER LN STE C
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3604
Mailing Address - Country:US
Mailing Address - Phone:303-404-9494
Mailing Address - Fax:303-404-2252
Practice Address - Street 1:12297 PENNSYLVANIA ST UNIT 3
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3165
Practice Address - Country:US
Practice Address - Phone:303-252-9400
Practice Address - Fax:303-255-9555
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0003748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305626Medicare PIN