Provider Demographics
NPI:1184634776
Name:DIGIACOMO, DAVID A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DIGIACOMO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:313 DECINO PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2493
Mailing Address - Country:US
Mailing Address - Phone:303-514-4554
Mailing Address - Fax:
Practice Address - Street 1:9108 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5121
Practice Address - Country:US
Practice Address - Phone:303-484-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102255331OtherOWCP FACILITY ID
CO06-6600Medicare Oscar/Certification