Provider Demographics
NPI:1831167469
Name:ZEVENBERGEN, ELIZABETH CLARITA (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARITA
Last Name:ZEVENBERGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLARITA
Other - Last Name:DRALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:135 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4105
Mailing Address - Country:US
Mailing Address - Phone:970-568-2575
Mailing Address - Fax:
Practice Address - Street 1:135 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4105
Practice Address - Country:US
Practice Address - Phone:970-568-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807230Medicare PIN