Provider Demographics
NPI:1326885427
Name:WADE, VERNIE S (DPT)
Entity type:Individual
Prefix:DR
First Name:VERNIE
Middle Name:S
Last Name:WADE
Suffix:
Gender:X
Credentials:DPT
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 1671
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-1671
Mailing Address - Country:US
Mailing Address - Phone:720-954-8366
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1671
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80502-1671
Practice Address - Country:US
Practice Address - Phone:720-954-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist