Basic Information
Provider Information
NPI: 1356875629
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALPERT
FirstName: TERESA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CO, C.PED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3055 ROSLYN ST UNIT 200
Address2:  
City: DENVER
State: CO
PostalCode: 802383324
CountryCode: US
TelephoneNumber: 7208480000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/13/2017
LastUpdateDate: 11/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X  N Other Service ProvidersSpecialist 
222Z00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist 

No ID Information.


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