Provider Demographics
NPI:1720673551
Name:KURTZ, SEBASTIAN RYAN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:RYAN
Last Name:KURTZ
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E DARTMOUTH AVE APT CC102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4808
Mailing Address - Country:US
Mailing Address - Phone:505-610-4071
Mailing Address - Fax:
Practice Address - Street 1:6400 S LEWISTON WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3000
Practice Address - Country:US
Practice Address - Phone:303-269-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00016292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer