Provider Demographics
NPI:1306410832
Name:KOLFRAT, TYLER JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:KOLFRAT
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 1:6825 MESA RIDGE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1784
Mailing Address - Country:US
Mailing Address - Phone:719-623-1110
Mailing Address - Fax:719-623-1144
Practice Address - Street 1:6825 MESA RIDGE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1784
Practice Address - Country:US
Practice Address - Phone:719-623-1110
Practice Address - Fax:719-623-1144
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
COPTL.0018089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306410832Medicaid