Healthcare Provider Details

I. General information

NPI: 1467640110
Provider Name (Legal Business Name): SHAYNE KINTZEL R.R.T. RCP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16525 W 63RD PL
GOLDEN CO
80403-7419
US

IV. Provider business mailing address

16525 W 63RD PL
GOLDEN CO
80403-7419
US

V. Phone/Fax

Practice location:
  • Phone: 303-507-1565
  • Fax:
Mailing address:
  • Phone: 303-507-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1420
License Number StateCO

VIII. Authorized Official

Name: JOSEPH SHAYNE KINTZEL
Title or Position: OWNER
Credential: RRT RCP
Phone: 303-507-1565