Provider Demographics
NPI:1821376922
Name:TEDROW, KELLY (RMT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TEDROW
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MISSION PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2442
Mailing Address - Country:US
Mailing Address - Phone:720-229-2681
Mailing Address - Fax:
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:#806
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:720-229-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-5287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist