Provider Demographics
NPI:1184901712
Name:DOUHAN, KRISTEN SUE (MED, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUE
Last Name:DOUHAN
Suffix:
Gender:F
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 PLAZA DR
Mailing Address - Street 2:# 100
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2344
Mailing Address - Country:US
Mailing Address - Phone:303-345-3242
Mailing Address - Fax:
Practice Address - Street 1:1060 PLAZA DR
Practice Address - Street 2:# 100
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2344
Practice Address - Country:US
Practice Address - Phone:303-345-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO514843YMBGMedicare PIN