Healthcare Provider Details

I. General information

NPI: 1356840235
Provider Name (Legal Business Name): KIMBERLY DIANE HUKILL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18900 E MAINSTREET
PARKER CO
80134-3493
US

IV. Provider business mailing address

22462 E UNION CIR
AURORA CO
80015-5540
US

V. Phone/Fax

Practice location:
  • Phone: 720-363-7670
  • Fax:
Mailing address:
  • Phone: 303-981-5074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0012096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: