Provider Demographics
NPI:1962162206
Name:BELISAIRO, KRISTEN (DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BELISAIRO
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 1:6851 S HOLLY CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1050
Mailing Address - Country:US
Mailing Address - Phone:720-644-0181
Mailing Address - Fax:
Practice Address - Street 1:6851 S HOLLY CIR STE 110
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1050
Practice Address - Country:US
Practice Address - Phone:720-644-0181
Practice Address - Fax:720-381-6868
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018116208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0018116OtherDPT LICENSE