Provider Demographics
NPI:1013272384
Name:KUTZ, JUSTIN TYLER (PTA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TYLER
Last Name:KUTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 S MONACO ST
Mailing Address - Street 2:UNIT 5044
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3490
Mailing Address - Country:US
Mailing Address - Phone:970-580-3373
Mailing Address - Fax:
Practice Address - Street 1:4380 S MONACO ST
Practice Address - Street 2:UNIT 5044
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3490
Practice Address - Country:US
Practice Address - Phone:970-580-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12813225200000X
KS14-02337225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant