Provider Demographics
NPI:1679114250
Name:MINEAR, KACEY (DPT)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:MINEAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 W GRANT RANCH BLVD APT 2332
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2662
Mailing Address - Country:US
Mailing Address - Phone:760-473-4491
Mailing Address - Fax:
Practice Address - Street 1:151 W MINERAL AVE STE 116A
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4510
Practice Address - Country:US
Practice Address - Phone:303-798-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00166112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic