MEDICARE: KELLY LYNN SAMMIS PT

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	11086	CO

General Provider Information

NPI Number	:	1356659627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN SAMMIS PT

Provider Business Mailing Address
First Line	:	3400 LARIMER ST UNIT 106
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2573
Country	:	US
Telephone Number	:	614-390-3970
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 MAIN ST STE 104
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1897
Country	:	US
Telephone Number	:	303-954-8423
Fax Number	:

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	01/25/2016

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