Healthcare Provider Details

I. General information

NPI: 1023930021
Provider Name (Legal Business Name): KIMBERLEY HALLSTED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 RECREATION WAY STE A
GRAND JUNCTION CO
81506-6025
US

IV. Provider business mailing address

226 N MESA ST
FRUITA CO
81521-2148
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-6100
  • Fax:
Mailing address:
  • Phone: 650-575-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: