Provider Demographics
NPI:1801984760
Name:HEAD, NECK AND TMJ THERAPY CENTER
Entity type:Organization
Organization Name:HEAD, NECK AND TMJ THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-394-2218
Mailing Address - Street 1:180 ADAMS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5222
Mailing Address - Country:US
Mailing Address - Phone:303-394-2218
Mailing Address - Fax:303-394-0049
Practice Address - Street 1:180 ADAMS ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5222
Practice Address - Country:US
Practice Address - Phone:303-394-2218
Practice Address - Fax:303-394-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC16133Medicare ID - Type Unspecified