Healthcare Provider Details

I. General information

NPI: 1972859924
Provider Name (Legal Business Name): ALEKSANDRA V KUYAROV PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E PRENTICE AVE STE 207
GREENWOOD VILLAGE CO
80111-2905
US

IV. Provider business mailing address

19424 E 58TH PL
AURORA CO
80019-2027
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0012878
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: