Healthcare Provider Details

I. General information

NPI: 1033326475
Provider Name (Legal Business Name): TERRY LYNN KASINO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S ALTON WAY SUITE B-110
CENTENNIAL CO
80112-2201
US

IV. Provider business mailing address

9888 E VASSAR DR I-102
DENVER CO
80231-5913
US

V. Phone/Fax

Practice location:
  • Phone: 720-489-0790
  • Fax:
Mailing address:
  • Phone: 720-281-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: