Provider Demographics
NPI:1104363787
Name:FLYNN, KAITLYN (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9399 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8506
Mailing Address - Country:US
Mailing Address - Phone:720-777-6710
Mailing Address - Fax:
Practice Address - Street 1:9399 CROWN CREST BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8506
Practice Address - Country:US
Practice Address - Phone:720-777-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00139282251S0007X
NY0374162251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports