Provider Demographics
NPI:1407905714
Name:DIFRANK, KATHRYN DOROTHY (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DOROTHY
Last Name:DIFRANK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-0983
Mailing Address - Country:US
Mailing Address - Phone:720-470-0249
Mailing Address - Fax:
Practice Address - Street 1:652 MELISSA LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2819
Practice Address - Country:US
Practice Address - Phone:720-470-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22175857Medicaid