MEDICARE: SIGNATURE PHYSICAL THERAPY AND WELLNESS PLLC KIMBERLY SIPPLE DEMUN SOLE MBR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1508794421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE PHYSICAL THERAPY AND WELLNESS PLLC KIMBERLY SIPPLE DEMUN SOLE MBR

Provider Business Mailing Address
First Line	:	5836 E IRISH PL
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-6518
Country	:	US
Telephone Number	:	952-994-0178
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 E IRISH PL
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-6518
Country	:	US
Telephone Number	:	952-994-0178
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY SIPPLE DEMUN
Credential	:	PT
Telephone Number	:	952-994-0178

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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