Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PTL.0003944 | CO |
Y | 2251S0007X | Physical Therapist - Sports | PTL.0003944 | CO |
NPI | 1043480668 |
---|---|
Provider Name | Radhika Menon |
First Address | Boulder, CO 80303-4272 |
Second Address | Boulder, CO 80309-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2008 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64624722 | (05) | CO |