Provider Demographics
NPI:1972981751
Name:COUCHMAN, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:COUCHMAN
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 1:5101 S RIO GRANDE ST
Mailing Address - Street 2:9201
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8228
Mailing Address - Country:US
Mailing Address - Phone:319-621-6703
Mailing Address - Fax:
Practice Address - Street 1:5101 S RIO GRANDE ST
Practice Address - Street 2:9201
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8228
Practice Address - Country:US
Practice Address - Phone:319-621-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013584225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant