Provider Demographics
NPI:1306808803
Name:JUNTTONEN, RANDY J (PT)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:J
Last Name:JUNTTONEN
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 1:1 MERCADO ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-259-1378
Mailing Address - Fax:970-385-0620
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-385-0644
Practice Address - Fax:970-385-0620
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13436767Medicaid
COC377018Medicare PIN
CO13436767Medicaid