Provider Demographics
NPI:1881866358
Name:FLYNN, KRYSTAL R (PT, MPT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:R
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:R
Other - Last Name:CATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6450 BEAR PAW RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6450 BEAR PAW RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8208
Practice Address - Country:US
Practice Address - Phone:815-954-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016289225100000X
CO0010623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03295Medicare PIN
ILP00616419Medicare UPIN
ILR03294Medicare PIN
ILK51200Medicare PIN