Healthcare Provider Details

I. General information

NPI: 1760369508
Provider Name (Legal Business Name): KAYLEE JAWOISZ PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 BELMONT DR
LONGMONT CO
80503-2358
US

IV. Provider business mailing address

2517 31ST AVE
ROCK ISLAND IL
61201-6315
US

V. Phone/Fax

Practice location:
  • Phone: 303-963-5582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021362
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: