Provider Demographics
NPI:1083645816
Name:MAGUIRE, KRISTIN L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:MAGUIRE
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 1:1330 QUAIL LAKE LOOP
Mailing Address - Street 2:#100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-579-0230
Mailing Address - Fax:719-579-0277
Practice Address - Street 1:1330 QUAIL LAKE LOOP
Practice Address - Street 2:#100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-579-0230
Practice Address - Fax:719-579-0277
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7320225100000X
CO7320 PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804947Medicare UPIN
CO804947Medicare ID - Type Unspecified