Provider Demographics
NPI:1902155336
Name:PRINCE, SRIPRIYA MADURA (DPT)
Entity type:Individual
Prefix:MRS
First Name:SRIPRIYA
Middle Name:MADURA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:107 W 29TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2797
Mailing Address - Country:US
Mailing Address - Phone:970-663-6142
Mailing Address - Fax:970-635-3087
Practice Address - Street 1:2211 S COLLEGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1489
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY035496174400000X, 2251X0800X, 225100000X, 2251S0007X
CO141902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
12388094OtherCAQH
1902155336Medicare PIN
12388094OtherCAQH
CO528274YLX1Medicare UPIN