Healthcare Provider Details

I. General information

NPI: 1194455170
Provider Name (Legal Business Name): KISHI LEILANI KUYKENDALL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 POWERS CENTER PT
COLORADO SPRINGS CO
80920-7100
US

IV. Provider business mailing address

5963 DANCING SUN WAY
COLORADO SPRINGS CO
80911-8307
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-6022
  • Fax:
Mailing address:
  • Phone: 559-786-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: