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General NPI Number Information
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NPI Number | 1962055673
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Entity Type | Individual
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Provider Name | KELSIE TAYLOR PTA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 2205 W 29TH AVE
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City | DENVER
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State | CO
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Zip | 80211-3803
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Country | US
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Telephone | 303-485-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 6792 W 19TH PL APT 205
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City | LAKEWOOD
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State | CO
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Zip | 80214-1478
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Country | US
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Telephone | 714-604-6407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0014615
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License Number State | CO
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