Provider Demographics
NPI:1134289341
Name:EVANS, KELLI RENAE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENAE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20944 E CRESTLINE PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3624
Mailing Address - Country:US
Mailing Address - Phone:303-627-1676
Mailing Address - Fax:
Practice Address - Street 1:20944 E CRESTLINE PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3624
Practice Address - Country:US
Practice Address - Phone:303-627-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist