Healthcare Provider Details

I. General information

NPI: 1407345705
Provider Name (Legal Business Name): KAREN RENEE HATAMI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 COLORADO AVE APT D7
BOULDER CO
80303-1942
US

IV. Provider business mailing address

3480 COLORADO AVE APT D7
BOULDER CO
80303-1942
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-3644
  • Fax:
Mailing address:
  • Phone: 303-875-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3088
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier3088
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPHYSICAL THERAPY
# 2
Identifier9271
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPHYSICAL THERAPY
# 3
Identifier3088
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerP.T

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: