Provider Demographics
NPI:1922214485
Name:FARNER, KATE TILLIE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:TILLIE
Last Name:FARNER
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7310 S ALTON WAY
Mailing Address - Street 2:SUITE 6L
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2334
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:720-488-1988
Practice Address - Street 1:201 S ELM AVE
Practice Address - Street 2:#202
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-8267
Practice Address - Country:US
Practice Address - Phone:970-454-2560
Practice Address - Fax:970-454-2335
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO11229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA0969Medicare PIN