Provider Demographics
NPI:1962591040
Name:CABLE, KRISTA K (MSPT)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:K
Last Name:CABLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SOUTH CHERRY STREET
Mailing Address - Street 2:SUITE 640
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-330-0009
Mailing Address - Fax:303-333-1184
Practice Address - Street 1:425 SOUTH CHERRY STREET
Practice Address - Street 2:SUITE 640
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-330-0009
Practice Address - Fax:303-333-1184
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8632208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC500418OtherMEDICARE GROUP PIN
COC801897Medicare PIN
CO801897Medicare PIN