Healthcare Provider Details

I. General information

NPI: 1316515612
Provider Name (Legal Business Name): CLARE NICOLE GOLDKAMP PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25577 CONIFER RD
CONIFER CO
80433-9068
US

IV. Provider business mailing address

30 DORCLIN LN
SAINT LOUIS MO
63128-1427
US

V. Phone/Fax

Practice location:
  • Phone: 303-222-4321
  • Fax:
Mailing address:
  • Phone: 314-605-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP053966T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: