Healthcare Provider Details

I. General information

NPI: 1689455420
Provider Name (Legal Business Name): KRISTIN RAE ONEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S 21ST ST
COLORADO SPRINGS CO
80904-5123
US

IV. Provider business mailing address

5977 HARNEY DR
COLORADO SPRINGS CO
80924-4202
US

V. Phone/Fax

Practice location:
  • Phone: 719-329-1774
  • Fax: 719-633-5286
Mailing address:
  • Phone: 719-650-8942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0012842
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: