Provider Demographics
NPI:1376871301
Name:PARKER, KURT (PT)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3059
Mailing Address - Country:US
Mailing Address - Phone:719-486-2000
Mailing Address - Fax:719-486-2001
Practice Address - Street 1:1601 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3059
Practice Address - Country:US
Practice Address - Phone:719-486-2000
Practice Address - Fax:719-486-2001
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic