Provider Demographics
NPI:1750726923
Name:ROLES, JESSE (DPT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:ROLES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 PARKGLENN WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3883
Mailing Address - Country:US
Mailing Address - Phone:303-840-9202
Mailing Address - Fax:303-840-8928
Practice Address - Street 1:10345 PARKGLENN WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3883
Practice Address - Country:US
Practice Address - Phone:303-840-9202
Practice Address - Fax:303-840-8928
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40066225100000X
CO12237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO320699YV32Medicare UPIN