Provider Demographics
NPI:1124143854
Name:DMYTRIW, WILLIAM C (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:DMYTRIW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270217
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5003
Mailing Address - Country:US
Mailing Address - Phone:303-446-2200
Mailing Address - Fax:303-446-2201
Practice Address - Street 1:11025 N. DOVER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-446-2200
Practice Address - Fax:303-446-2201
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IMS67413OtherBCBS
A007OtherTRICARE