Provider Demographics
NPI:1588940183
Name:SIRVATKA, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:SIRVATKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 S BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-738-1900
Mailing Address - Fax:303-738-1493
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2632
Practice Address - Country:US
Practice Address - Phone:303-738-1900
Practice Address - Fax:303-739-1900
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO080402533174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080402533OtherATHLETIC TRAINER