Provider Demographics
NPI:1023367265
Name:RYAN, KRISTEN L (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:SODERBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:420 E 120TH AVE # 8
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1127
Mailing Address - Country:US
Mailing Address - Phone:303-280-3838
Mailing Address - Fax:
Practice Address - Street 1:420 E 120TH AVE # 8
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1127
Practice Address - Country:US
Practice Address - Phone:303-280-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0916225200000X
CO0012741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant