Provider Demographics
NPI:1730469305
Name:GORONCY, KATIE ANNE I
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANNE
Last Name:GORONCY
Suffix:I
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 1:2885 W LONG CIR APT C
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8178
Mailing Address - Country:US
Mailing Address - Phone:724-255-6154
Mailing Address - Fax:
Practice Address - Street 1:2885 W LONG CIR APT C
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8178
Practice Address - Country:US
Practice Address - Phone:724-255-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist