Provider Demographics
NPI:1205233756
Name:MONDELLO, JENNIFER (PT,DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MONDELLO
Suffix:
Gender:F
Credentials:PT,DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18995 W 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1081
Mailing Address - Country:US
Mailing Address - Phone:303-884-6803
Mailing Address - Fax:
Practice Address - Street 1:811 BRICKYARD CIR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8058
Practice Address - Country:US
Practice Address - Phone:541-951-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist