NPI 1053617779 · Physical Therapist · Anthem
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
BOULDER, 80303
Freshness: Unknown
Network Status
Listed with 1 carrier
DORA License
Expired
Medicare
Non-Medicare specialty
Care Compare
No Care Compare data
PECOS Enrollment
No PECOS data
Active NPI with specialty classification
DORA license expired or revoked
No Medicare billing · No electronic endpoint · No PECOS enrollment
Single address source (NPPES)
Weak network corroboration
1 network across 1 carrier
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.