Provider Demographics
NPI:1063057842
Name:BOISTURE, NANCY SUE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:BOISTURE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 SOUTH BOSTON STREET
Mailing Address - Street 2:APT. #F102
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-229-0707
Mailing Address - Fax:
Practice Address - Street 1:393 SOUTH HARLAN STREET
Practice Address - Street 2:SUITE 170
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-233-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01240225100000X
CO4183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist