Provider Demographics
NPI:1639308125
Name:PLUMMER, KATHLEEN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 S FRASER ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4533
Mailing Address - Country:US
Mailing Address - Phone:303-695-1609
Mailing Address - Fax:303-695-0382
Practice Address - Street 1:2226 S FRASER ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4533
Practice Address - Country:US
Practice Address - Phone:303-695-1609
Practice Address - Fax:303-695-0382
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist