Provider Demographics
NPI:1710679600
Name:KLUTZ, TIANA LEIGH (DPT)
Entity Type:Individual
Prefix:MS
First Name:TIANA
Middle Name:LEIGH
Last Name:KLUTZ
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 1:4920 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1362
Mailing Address - Country:US
Mailing Address - Phone:360-356-2064
Mailing Address - Fax:
Practice Address - Street 1:11265 DECATUR ST STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-4793
Practice Address - Country:US
Practice Address - Phone:303-561-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist