Provider Demographics
NPI:1467489401
Name:MAYWHORT, KERI RAE
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:RAE
Last Name:MAYWHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:RAE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10200 PARK MEADOWS DR
Mailing Address - Street 2:#1714
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5456
Mailing Address - Country:US
Mailing Address - Phone:720-220-5499
Mailing Address - Fax:
Practice Address - Street 1:7340 S ALTON WAY
Practice Address - Street 2:STE 11-D
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2335
Practice Address - Country:US
Practice Address - Phone:720-493-1181
Practice Address - Fax:720-493-1191
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO458118Medicare ID - Type Unspecified