Provider Demographics
NPI:1235586389
Name:KAM, RYAN KAPENA (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KAPENA
Last Name:KAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 ROSLYN WAY UNIT 304
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2413
Mailing Address - Country:US
Mailing Address - Phone:808-381-9813
Mailing Address - Fax:
Practice Address - Street 1:4380 S SYRACUSE ST STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2691
Practice Address - Country:US
Practice Address - Phone:303-488-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist