Provider Demographics
NPI:1588813315
Name:KINCAID, CHAD BENTON (CP , PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:BENTON
Last Name:KINCAID
Suffix:
Gender:M
Credentials:CP , PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 MONUMENT CT
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3053
Mailing Address - Country:US
Mailing Address - Phone:970-639-2606
Mailing Address - Fax:
Practice Address - Street 1:1380 MONUMENT CT
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-3053
Practice Address - Country:US
Practice Address - Phone:970-639-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP003523224P00000X
CO5335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist