Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5836 E IRISH PL
CENTENNIAL CO
80112-6518
US

IV. Provider business mailing address

5836 E IRISH PL
CENTENNIAL CO
80112-6518
US

V. Phone/Fax

Practice location:
  • Phone: 952-994-0178
  • Fax:
Mailing address:
  • Phone: 952-994-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY SIPPLE DEMUN
Title or Position: OWNER
Credential: PT
Phone: 952-994-0178