Provider Demographics
NPI:1134352347
Name:KINCAID, JENNA M (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:KINCAID
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1236
Mailing Address - Country:US
Mailing Address - Phone:970-223-8293
Mailing Address - Fax:
Practice Address - Street 1:140 EAST BOARDWALK DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3153
Practice Address - Country:US
Practice Address - Phone:970-223-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10916OtherCO LICENSE #
CO10916OtherCO LICENSE #