Provider Demographics
NPI:1578895173
Name:YASUMURA, KATHLEEN (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:YASUMURA
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 1:2875 MAROON BELLS AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1560
Mailing Address - Country:US
Mailing Address - Phone:719-593-0586
Mailing Address - Fax:719-593-0586
Practice Address - Street 1:8540 SCARBOROUGH DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7502
Practice Address - Country:US
Practice Address - Phone:719-630-7500
Practice Address - Fax:719-314-0150
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist