Provider Demographics
NPI:1992053706
Name:RAFOLS, SANDRA MENDOZA (PTA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MENDOZA
Last Name:RAFOLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S WORLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1805
Mailing Address - Country:US
Mailing Address - Phone:970-817-8174
Mailing Address - Fax:
Practice Address - Street 1:618 S. INTEROCEAN AVE.
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734
Practice Address - Country:US
Practice Address - Phone:970-854-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012870225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant