Provider Demographics
NPI:1144587247
Name:MARGARUCCI, KEVIN (ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MARGARUCCI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 DELMONICO DR
Mailing Address - Street 2:UNIT #204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1339
Mailing Address - Country:US
Mailing Address - Phone:719-867-8150
Mailing Address - Fax:
Practice Address - Street 1:1300 HIGBY RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7406
Practice Address - Country:US
Practice Address - Phone:719-867-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer