Basic Information
Provider Information
NPI: 1720190432
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSTRONIC
FirstName: TOM
MiddleName: JOHN
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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: 1889 WOODMOOR DR.
Address2:  
City: MONUMENT
State: CO
PostalCode: 801329066
CountryCode: US
TelephoneNumber: 7194816868
FaxNumber: 7194816877
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 12/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X9307COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home