Provider Demographics
NPI:1790727089
Name:LAVALLEY, KRIS ANNE (MSPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:ANNE
Last Name:LAVALLEY
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 S QUINCE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2104
Mailing Address - Country:US
Mailing Address - Phone:303-504-9298
Mailing Address - Fax:
Practice Address - Street 1:7600 E EASTMAN AVE #405
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:720-747-7788
Practice Address - Fax:720-747-7217
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist