Provider Demographics
NPI:1649683442
Name:BOURGEOIS, KASSIDY (PT)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KASSIDY
Other - Middle Name:
Other - Last Name:PIERATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4404 BARRANCA LN UNIT 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7432
Practice Address - Country:US
Practice Address - Phone:720-733-5270
Practice Address - Fax:720-733-5281
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist