Provider Demographics
NPI:1558809327
Name:COLAGRECO, KAITLYN
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:COLAGRECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 S ALTON WAY
Mailing Address - Street 2:STE 11-D
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2323
Mailing Address - Country:US
Mailing Address - Phone:720-493-1181
Mailing Address - Fax:720-493-1191
Practice Address - Street 1:331 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-2277
Practice Address - Country:US
Practice Address - Phone:610-558-5866
Practice Address - Fax:610-558-6103
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0257632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic