Provider Demographics
NPI:1104800713
Name:DEINES, ERIC R (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:DEINES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8033 S RACE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3217
Mailing Address - Country:US
Mailing Address - Phone:303-909-9393
Mailing Address - Fax:303-738-5544
Practice Address - Street 1:8033 S RACE WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3217
Practice Address - Country:US
Practice Address - Phone:303-909-9393
Practice Address - Fax:303-738-5544
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800281Medicare ID - Type Unspecified
COCO41385Medicare PIN