Provider Demographics
NPI:1477670719
Name:KANABY, PATRICIA HELEN (CCMPT, RPT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:HELEN
Last Name:KANABY
Suffix:
Gender:F
Credentials:CCMPT, RPT
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:HELEN
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMPT, RPT
Mailing Address - Street 1:1612 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-1925
Mailing Address - Country:US
Mailing Address - Phone:719-477-6870
Mailing Address - Fax:719-477-1483
Practice Address - Street 1:1612 S 8TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1925
Practice Address - Country:US
Practice Address - Phone:719-477-6870
Practice Address - Fax:719-477-1483
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist