Provider Demographics
NPI:1619992534
Name:KITANI, LENORE JOAN (PT)
Entity Type:Individual
Prefix:MS
First Name:LENORE
Middle Name:JOAN
Last Name:KITANI
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 1:150 OLD LARAMIE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7018
Mailing Address - Country:US
Mailing Address - Phone:303-665-8747
Mailing Address - Fax:303-926-0184
Practice Address - Street 1:150 OLD LARAMIE TRL E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7018
Practice Address - Country:US
Practice Address - Phone:303-665-8747
Practice Address - Fax:303-926-0184
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2745225100000X
CO9724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810039Medicare UPIN