Provider Demographics
NPI:1720021959
Name:MCDONNEL, KRISTI S (PT, MTC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:S
Last Name:MCDONNEL
Suffix:
Gender:F
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 557
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0557
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:9830 W I70 FRONTAGE RD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-467-4100
Practice Address - Fax:303-420-0836
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39735729Medicaid
CO39735729Medicaid