Provider Demographics
NPI:1730426263
Name:BELLINGER, KRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BELLINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 VALMONT RD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2157
Mailing Address - Country:US
Mailing Address - Phone:720-291-0792
Mailing Address - Fax:
Practice Address - Street 1:3171 VALMONT RD
Practice Address - Street 2:UNIT #1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2157
Practice Address - Country:US
Practice Address - Phone:720-291-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant