Provider Demographics
NPI:1669087177
Name:KUCERA, MICHELL LYNN (PT)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:LYNN
Last Name:KUCERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 GARFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7293
Mailing Address - Country:US
Mailing Address - Phone:303-386-3243
Mailing Address - Fax:
Practice Address - Street 1:23830 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:CO
Practice Address - Zip Code:80645-8612
Practice Address - Country:US
Practice Address - Phone:970-451-1234
Practice Address - Fax:970-284-7892
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0009428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist