Provider Demographics
NPI:1992752174
Name:GONDER, NANCY L (MSPT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:GONDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10081 WADSWORTH PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3827
Mailing Address - Country:US
Mailing Address - Phone:303-694-2295
Mailing Address - Fax:303-694-1843
Practice Address - Street 1:1371 E HECLA DR
Practice Address - Street 2:STE E
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2327
Practice Address - Country:US
Practice Address - Phone:303-665-6064
Practice Address - Fax:303-665-5493
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066600Medicare Oscar/Certification
CA805017Medicare ID - Type UnspecifiedPART B GROUP NUMBER