Provider Demographics
NPI:1043477763
Name:PHELPS, KIMBERLY R (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:R
Last Name:PHELPS
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 1:5173 S TABOR WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6240
Mailing Address - Country:US
Mailing Address - Phone:303-790-1910
Mailing Address - Fax:303-792-2479
Practice Address - Street 1:10001 S OSWEGO ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3786
Practice Address - Country:US
Practice Address - Phone:303-790-1910
Practice Address - Fax:303-792-2479
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86603230Medicaid