Provider Demographics
NPI:1639640774
Name:TEDROW, KRISTA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:TEDROW
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 1:15210 SPIRITWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-8878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 S WEBER ST STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1920
Practice Address - Country:US
Practice Address - Phone:719-630-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist