Provider Demographics
NPI:1912185877
Name:KANGIOR, STEPHEN R (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:KANGIOR
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 SPRINGLAKE CIR W
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3747
Mailing Address - Country:US
Mailing Address - Phone:719-344-9393
Mailing Address - Fax:
Practice Address - Street 1:575 KINCHELOE LOOP
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1194
Practice Address - Country:US
Practice Address - Phone:719-554-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-03
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10962251X0800X
CO5457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025428900Medicaid
NE10025429000Medicaid
NE10025429100Medicaid
NE10025429200Medicaid
NE10025429300Medicaid
NE10025429200Medicaid
NE10025429300Medicaid