NPI 1902106578 · Physical Therapist in Private Practice · Anthem
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
CASTLE ROCK, 80104
Freshness: Unknown
Network Status
Listed with 1 carrier
DORA License
Expired
Medicare
Non-Medicare specialty
98 beneficiaries
$94,126.43 total payment
Specialty: Physical Therapist in Private Practice
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Active NPI with specialty classification
DORA license expired or revoked
Active Medicare billing confirmed
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.