Provider Demographics
NPI:1003864711
Name:MACOMBER, KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 S. RIDGELINE BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-683-1877
Mailing Address - Fax:303-683-1484
Practice Address - Street 1:9137 S. RIDGELINE BLVD
Practice Address - Street 2:STE 140
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-8012
Practice Address - Country:US
Practice Address - Phone:303-683-1877
Practice Address - Fax:303-683-1484
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist