Healthcare Provider Details

I. General information

NPI: 1649579418
Provider Name (Legal Business Name): KATHERINE ANN NIKOLAUS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ANN HARBUT P.T.

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR
COLORADO SPRINGS CO
80920-7502
US

IV. Provider business mailing address

15235 BOVARY CT
COLORADO SPRINGS CO
80921-2547
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax: 719-314-0150
Mailing address:
  • Phone: 719-481-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5753
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 12887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: