Provider Demographics
NPI:1750793386
Name:BAUTISTA, JONATHAN (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 E JEFFERSON AVE APT 11E
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1593
Mailing Address - Country:US
Mailing Address - Phone:720-329-5866
Mailing Address - Fax:
Practice Address - Street 1:8000 E QUINCY AVE #1700
Practice Address - Street 2:SARAHCARE AT DTC
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237
Practice Address - Country:US
Practice Address - Phone:303-579-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-0010447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist