Provider Demographics
NPI:1487984548
Name:NOTEBOOM, JON TIMOTHY (PT)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:TIMOTHY
Last Name:NOTEBOOM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:NOTEBOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3333 REGIS BLVD
Mailing Address - Street 2:SCHOOL OF PHYSICAL THERAPY, G-4
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1154
Mailing Address - Country:US
Mailing Address - Phone:303-458-4268
Mailing Address - Fax:303-964-5474
Practice Address - Street 1:3333 REGIS BLVD
Practice Address - Street 2:SCHOOL OF PHYSICAL THERAPY, G-4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1154
Practice Address - Country:US
Practice Address - Phone:303-458-4268
Practice Address - Fax:303-964-5474
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3407225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic