Provider Demographics
NPI:1154515815
Name:KT PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:KT PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-747-8444
Mailing Address - Street 1:2993 S. PEORIA STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5704
Mailing Address - Country:US
Mailing Address - Phone:720-747-8444
Mailing Address - Fax:720-747-4712
Practice Address - Street 1:2993 S. PEORIA STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5704
Practice Address - Country:US
Practice Address - Phone:720-747-8444
Practice Address - Fax:720-747-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1864261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C457208Medicare PIN
C457218Medicare PIN