Basic Information
| Provider Information | |||||||||
| NPI: | 1184636011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPPE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | M.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6979 S HOLLY CIR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801121577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036942295 | ||||||||
| FaxNumber: | 3036941843 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 W SPENCER AVE | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706412266 | ||||||||
| FaxNumber: | 9706410334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8225 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.