Provider Demographics
NPI:1700254828
Name:BOVENZI, YVONNE (PTA)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:BOVENZI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11993 W HORNSILVER MTN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3231
Mailing Address - Country:US
Mailing Address - Phone:720-261-8105
Mailing Address - Fax:
Practice Address - Street 1:4601 E ASBURY CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4722
Practice Address - Country:US
Practice Address - Phone:303-757-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012417225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant