Individual
IVAN IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2611 JONES AVE, PUEBLO, CO 81004-2650
(719) 564-1735
Mailing address
655 S WILLOW ST STE 128, MANCHESTER, NH 03103-5723
(800) 995-2673
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
CP017621T
CO
225100000X
Physical Therapist
J1-0004181
DE
225100000X
Physical Therapist
—
—
Other
Enumeration date
02/10/2020
Last updated
01/19/2023
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