Provider Demographics
NPI:1134147671
Name:INGEBRETSON, EMBER MARIE (PT, MPT, DPT)
Entity type:Individual
Prefix:
First Name:EMBER
Middle Name:MARIE
Last Name:INGEBRETSON
Suffix:
Gender:F
Credentials:PT, MPT, DPT
Other - Prefix:
Other - First Name:EMBER
Other - Middle Name:MARIE
Other - Last Name:LOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 SPRUCE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4617
Mailing Address - Country:US
Mailing Address - Phone:303-444-3359
Mailing Address - Fax:303-545-9527
Practice Address - Street 1:2400 SPRUCE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4617
Practice Address - Country:US
Practice Address - Phone:303-444-3359
Practice Address - Fax:303-545-9527
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803646Medicare ID - Type Unspecified