Healthcare Provider Details

I. General information

NPI: 1497887525
Provider Name (Legal Business Name): MICHAEL KOHM PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 MANHATTAN CIR STE 102
BOULDER CO
80303-4200
US

IV. Provider business mailing address

115 MONARCH CT
LOUISVILLE CO
80027-1242
US

V. Phone/Fax

Practice location:
  • Phone: 720-352-0678
  • Fax: 720-441-0485
Mailing address:
  • Phone: 720-352-0678
  • Fax: 720-441-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5050
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5050
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPT LICENSE #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: