Provider Demographics
NPI:1730626680
Name:MATSON-RUFENACHT, ANGELA IRENE (ATC, PTA, LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:IRENE
Last Name:MATSON-RUFENACHT
Suffix:
Gender:F
Credentials:ATC, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18505 BIRDSEYE VW
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-9379
Mailing Address - Country:US
Mailing Address - Phone:719-237-7388
Mailing Address - Fax:
Practice Address - Street 1:18505 BIRDSEYE VW
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-9379
Practice Address - Country:US
Practice Address - Phone:719-237-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012631225200000X
COAT.00007762255A2300X
COMT.0008369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist