MEDICARE: KELLY FRATESI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0013800	CO

General Provider Information

NPI Number	:	1235599424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY FRATESI

Provider Business Mailing Address
First Line	:	1622 W 33RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 W 33RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3507
Country	:	US
Telephone Number	:	662-820-5355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/01/2016

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