Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | CO |
NPI | 1104205533 |
---|---|
Provider Name | Dr. Summer Angela Mahler |
First Address | Centennial, CO 80015-5224 |
Second Address | Centennial, CO 80015-5224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 18/05/2015 |