Provider Demographics
NPI:1689270712
Name:EUCKER, KAITLYNN PAIGE
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:PAIGE
Last Name:EUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 TENDERFOOT HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3903
Mailing Address - Country:US
Mailing Address - Phone:719-576-8380
Mailing Address - Fax:
Practice Address - Street 1:3705 SHEFFIELD LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4842
Practice Address - Country:US
Practice Address - Phone:509-832-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014850208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00000OtherOTHER