Healthcare Provider Details

I. General information

NPI: 1164961397
Provider Name (Legal Business Name): KIM LAKOS HUTCHINSON RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S HIGH ST
DENVER CO
80209-4529
US

IV. Provider business mailing address

714 S HIGH ST
DENVER CO
80209-4529
US

V. Phone/Fax

Practice location:
  • Phone: 303-725-4511
  • Fax:
Mailing address:
  • Phone: 303-725-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number222
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: