Provider Demographics
NPI:1578143053
Name:HOUSTON, KIMBERLY G (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UINTA WAY
Mailing Address - Street 2:STE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7198
Mailing Address - Country:US
Mailing Address - Phone:303-856-3299
Mailing Address - Fax:303-856-7787
Practice Address - Street 1:495 UINTA WAY STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7198
Practice Address - Country:US
Practice Address - Phone:303-856-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist