Provider Demographics
NPI:1306140918
Name:CROVELLI, JESSICA LYNN (DPT, CKTP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CROVELLI
Suffix:
Gender:F
Credentials:DPT, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7395 W EASTMAN PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5006
Mailing Address - Country:US
Mailing Address - Phone:720-838-2909
Mailing Address - Fax:
Practice Address - Street 1:7395 W EASTMAN PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5006
Practice Address - Country:US
Practice Address - Phone:720-838-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist