Provider Demographics
NPI:1235679754
Name:KROONENBERG, MARCY
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:KROONENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:KROONENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:9231 ASPEN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1522
Mailing Address - Country:US
Mailing Address - Phone:720-351-9492
Mailing Address - Fax:
Practice Address - Street 1:300 E HAMPDEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2638
Practice Address - Country:US
Practice Address - Phone:303-781-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist