Provider Demographics
NPI:1275635773
Name:STATES, KRISTY JOELLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:JOELLE
Last Name:STATES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 S LINDEN WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2161
Mailing Address - Country:US
Mailing Address - Phone:303-753-6611
Mailing Address - Fax:
Practice Address - Street 1:1325 S COLORADO BLVD STE 206 BLDG B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3311
Practice Address - Country:US
Practice Address - Phone:303-753-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine