Provider Demographics
NPI:1760179097
Name:ROBERTSON, KATIE LINNE (LMT, CNA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LINNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 PRICKLY PEAR CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8956
Mailing Address - Country:US
Mailing Address - Phone:720-209-3353
Mailing Address - Fax:
Practice Address - Street 1:19767 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7400
Practice Address - Country:US
Practice Address - Phone:303-841-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00757002376K00000X
COMT.0005406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide