Provider Demographics
NPI:1851848170
Name:PROBST, KIRSTEN DOROTHY
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:DOROTHY
Last Name:PROBST
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 1:237 N IDER ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1709
Mailing Address - Country:US
Mailing Address - Phone:720-839-8460
Mailing Address - Fax:
Practice Address - Street 1:237 N IDER ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-1709
Practice Address - Country:US
Practice Address - Phone:720-839-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program