Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5349 | CO |
N | 2251G0304X | Physical Therapist - Geriatrics | 5349 | CO |
N | 2251N0400X | Physical Therapist - Neurology | 5349 | CO |
N | 2251P0200X | Physical Therapist - Pediatrics | 5349 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 5349 | CO |
NPI | 1699033746 |
---|---|
Provider Name | Petra Landfester |
First Address | Boulder, CO 80302-8026 |
Second Address | Boulder, CO 80305-6557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 26/04/2012 |