Provider Demographics
NPI:1407345705
Name:HATAMI, KAREN RENEE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:HATAMI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 COLORADO AVE APT D7
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1942
Mailing Address - Country:US
Mailing Address - Phone:303-875-3644
Mailing Address - Fax:
Practice Address - Street 1:3480 COLORADO AVE APT D7
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1942
Practice Address - Country:US
Practice Address - Phone:303-875-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3088261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3088OtherPHYSICAL THERAPY
CO9271OtherPHYSICAL THERAPY
CO3088OtherP.T