Provider Demographics
NPI:1003424177
Name:RONAN, KIRSTEN J I
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:J
Last Name:RONAN
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 TANAKA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6898
Mailing Address - Country:US
Mailing Address - Phone:720-232-5188
Mailing Address - Fax:
Practice Address - Street 1:2195 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2538
Practice Address - Country:US
Practice Address - Phone:303-659-1824
Practice Address - Fax:303-659-1835
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12055225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant