Healthcare Provider Details

I. General information

NPI: 1427770106
Provider Name (Legal Business Name): KATELYN ANN PIKE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PROFESSIONAL PL STE 201
COLORADO SPRINGS CO
80904-8140
US

IV. Provider business mailing address

1046 NORWOOD AVE
COLORADO SPRINGS CO
80905-3502
US

V. Phone/Fax

Practice location:
  • Phone: 719-227-7079
  • Fax:
Mailing address:
  • Phone: 719-474-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0015176
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: