Provider Demographics
NPI:1104516400
Name:AUTEN, KYRA ELISE (DPT)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:ELISE
Last Name:AUTEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1054
Mailing Address - Country:US
Mailing Address - Phone:818-427-6635
Mailing Address - Fax:
Practice Address - Street 1:3448 BRIGHTON BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-5023
Practice Address - Country:US
Practice Address - Phone:303-285-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist