Provider Demographics
NPI:1952786436
Name:VENTURA, NELSON JR
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:VENTURA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 S IOLA ST APT 203
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4068
Mailing Address - Country:US
Mailing Address - Phone:772-233-2886
Mailing Address - Fax:
Practice Address - Street 1:500 GENEVA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-4305
Practice Address - Country:US
Practice Address - Phone:720-859-7887
Practice Address - Fax:720-859-7744
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist