Provider Demographics
NPI:1356769228
Name:RIEGEL, JENNIFER LYNNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:RIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-940-1611
Mailing Address - Fax:303-432-2296
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE #10
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-940-1611
Practice Address - Fax:303-432-2296
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL 0007125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist