Provider Demographics
NPI:1104296789
Name:POISSANT, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:POISSANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 9TH AVE
Mailing Address - Street 2:#4404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4032
Mailing Address - Country:US
Mailing Address - Phone:315-941-0921
Mailing Address - Fax:
Practice Address - Street 1:4700 EAST HALE PARKWAY
Practice Address - Street 2:#550
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-370-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist