Provider Demographics
NPI:1063988137
Name:SPYKSTRA, CATHERINE (ATC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SPYKSTRA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:BUCCINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9687 W CHATFIELD AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-9222
Mailing Address - Country:US
Mailing Address - Phone:770-906-7745
Mailing Address - Fax:
Practice Address - Street 1:29300 BUFFALO PARK RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7432
Practice Address - Country:US
Practice Address - Phone:303-982-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20000224072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer