Provider Demographics
NPI:1891743126
Name:CULJAK, IOLANTHE (PT)
Entity type:Individual
Prefix:MS
First Name:IOLANTHE
Middle Name:
Last Name:CULJAK
Suffix:
Gender:F
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:PO BOX 3353
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-3353
Mailing Address - Country:US
Mailing Address - Phone:970-586-1754
Mailing Address - Fax:866-461-8187
Practice Address - Street 1:145 E ELKHORN
Practice Address - Street 2:#200
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:970-586-1754
Practice Address - Fax:866-461-8187
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803690Medicare ID - Type UnspecifiedMEDICARE INDIV #