Provider Demographics
NPI:1568001501
Name:HAMBLETON, KELLY ANN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:HAMBLETON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12454 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9422
Mailing Address - Country:US
Mailing Address - Phone:720-202-4178
Mailing Address - Fax:
Practice Address - Street 1:8501 TURNPIKE DR UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7042
Practice Address - Country:US
Practice Address - Phone:303-430-2490
Practice Address - Fax:303-430-6479
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31142251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics