Healthcare Provider Details

I. General information

NPI: 1104363787
Provider Name (Legal Business Name): KAITLYN FLYNN PT, DPT, SCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9399 CROWN CREST BLVD SUITE 300
PARKER CO
80138-8506
US

IV. Provider business mailing address

9399 CROWN CREST BLVD SUITE 300
PARKER CO
80138-8506
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-6710
  • Fax:
Mailing address:
  • Phone: 720-777-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTL.0013928
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number037416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: