Provider Demographics
NPI:1386277671
Name:TAYLOR, KIMBERLY ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N PARK ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3340
Mailing Address - Country:US
Mailing Address - Phone:970-516-1600
Mailing Address - Fax:970-459-3048
Practice Address - Street 1:111 N PARK ST STE B
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3340
Practice Address - Country:US
Practice Address - Phone:970-516-1600
Practice Address - Fax:970-459-3048
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16851208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation