Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 1098 | CO |
NPI | 1659544401 |
---|---|
Provider Name | John Mark Disorbio |
First Address | Evergreen, CO 80437-2950 |
Second Address | Lakewood, CO 80228-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 31/07/2014 |