Provider Demographics
NPI:1972376747
Name:KITTLESON, JENNIFER KRISTINE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:KITTLESON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4730
Mailing Address - Country:US
Mailing Address - Phone:303-895-7655
Mailing Address - Fax:
Practice Address - Street 1:1055 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4730
Practice Address - Country:US
Practice Address - Phone:303-895-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0006442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist