Provider Demographics
NPI:1912284548
Name:GULMANTOVICZ, LORI BETH (ATC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:GULMANTOVICZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11590 KINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7689
Mailing Address - Country:US
Mailing Address - Phone:303-288-4016
Mailing Address - Fax:
Practice Address - Street 1:70 BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-5916
Practice Address - Country:US
Practice Address - Phone:303-350-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer