Provider Demographics
NPI:1790144632
Name:KANERIA, KRUPABEN
Entity Type:Individual
Prefix:
First Name:KRUPABEN
Middle Name:
Last Name:KANERIA
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 1:6255 HABITAT DR
Mailing Address - Street 2:APT 3026
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3216
Mailing Address - Country:US
Mailing Address - Phone:203-645-7595
Mailing Address - Fax:
Practice Address - Street 1:6255 HABITAT DR
Practice Address - Street 2:APT 3026
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3216
Practice Address - Country:US
Practice Address - Phone:203-645-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist