Basic Information
| Provider Information | |||||||||
| NPI: | 1124295787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REEDER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9830 I-70 FRONTAGE ROAD SOUTH | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800331724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674100 | ||||||||
| FaxNumber: | 3034200836 | ||||||||
| Practice Location | |||||||||
| Address1: | 9830 I-70 FRONTAGE ROAD SOUTH | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800331724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674100 | ||||||||
| FaxNumber: | 3034200836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL-4562 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 48582743 | 05 | CO | MEDICAID | P00691945 | 01 | CO | MEDICARE RAILROAD | OTHER |