Provider Demographics
NPI:1629047691
Name:DESSNER, ELIZABETH A (PT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:DESSNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 SCARLET IBIS LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7147
Mailing Address - Country:US
Mailing Address - Phone:563-260-1156
Mailing Address - Fax:
Practice Address - Street 1:5602 SCARLET IBIS LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7147
Practice Address - Country:US
Practice Address - Phone:563-260-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02605225100000X
COPTL.0014563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14722OtherBC/BS PROVIDER NUMBER
IA0434340Medicaid
IA14722OtherBC/BS PROVIDER NUMBER