Provider Demographics
NPI:1215057351
Name:WEST, JON CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:CHARLES
Last Name:WEST
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 1:356 S TAFT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9510
Mailing Address - Country:US
Mailing Address - Phone:720-339-5552
Mailing Address - Fax:303-402-1665
Practice Address - Street 1:315 W SOUTH BOULDER RD
Practice Address - Street 2:#100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1156
Practice Address - Country:US
Practice Address - Phone:303-601-6666
Practice Address - Fax:303-447-3390
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9624OtherCO LICENSE
CO9624OtherCO LICENSE