Provider Demographics
NPI:1992306799
Name:DENOVELLIS, KRISTA (CMT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:DENOVELLIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 S COLORADO BLVD UNIT 329
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4988
Mailing Address - Country:US
Mailing Address - Phone:720-840-5346
Mailing Address - Fax:
Practice Address - Street 1:3785 GROVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2746
Practice Address - Country:US
Practice Address - Phone:720-840-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist