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Individual

MR. DOUGLAS MERRILL WISOFF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHYSICAL THERAPIST

Contact information

Practice address
1295 S BROADWAY ST, SUITE B, BOULDER, CO 80305-6768
(303) 499-2062
Mailing address
PO BOX 3602, BOULDER, CO 80307-3602
(303) 499-2062

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3112
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3112
PHYSICAL THERAPY LICENSE
CO
Enumeration date
01/08/2007
Last updated
07/08/2007
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