Provider Demographics
NPI:1801871751
Name:KENENS, TARESA LYNN (PT)
Entity type:Individual
Prefix:
First Name:TARESA
Middle Name:LYNN
Last Name:KENENS
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 1:4105 BRIARGATE PKWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3480
Mailing Address - Country:US
Mailing Address - Phone:719-282-2320
Mailing Address - Fax:719-282-2330
Practice Address - Street 1:4105 BRIARGATE PKWY
Practice Address - Street 2:SUITE 255
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3480
Practice Address - Country:US
Practice Address - Phone:719-282-2320
Practice Address - Fax:719-282-2330
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 7027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802515Medicare ID - Type UnspecifiedMEDICARE NUMBER