Healthcare Provider Details

I. General information

NPI: 1013272384
Provider Name (Legal Business Name): JUSTIN TYLER KUTZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 S MONACO ST UNIT 5044
DENVER CO
80237-3490
US

IV. Provider business mailing address

4380 S MONACO ST UNIT 5044
DENVER CO
80237-3490
US

V. Phone/Fax

Practice location:
  • Phone: 970-580-3373
  • Fax:
Mailing address:
  • Phone: 970-580-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number12813
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02337
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: