Provider Demographics
NPI:1457840910
Name:GODSIL, KRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:GODSIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:INGRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9707 BURBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6257
Mailing Address - Country:US
Mailing Address - Phone:402-320-5109
Mailing Address - Fax:
Practice Address - Street 1:13606 XAVIER LN STE C
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3604
Practice Address - Country:US
Practice Address - Phone:303-404-9494
Practice Address - Fax:303-404-2252
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist