Provider Demographics
NPI:1669420287
Name:KAISER, KIMBERLY (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KAISER
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 1:2942 EVERGREEN PKWY
Mailing Address - Street 2:#100
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7909
Mailing Address - Country:US
Mailing Address - Phone:303-670-4802
Mailing Address - Fax:303-670-4526
Practice Address - Street 1:2942 EVERGREEN PKWY
Practice Address - Street 2:#100
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7909
Practice Address - Country:US
Practice Address - Phone:303-670-4802
Practice Address - Fax:303-670-4526
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4323225100000X
WI3079024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCN3013Medicare PIN