MEDICARE: ROBERT KANNAKA

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	7883	CO

General Provider Information

NPI Number	:	1760430813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KANNAKA

Provider Business Mailing Address
First Line	:	1805 S BELLAIRE ST
Second Line	:	STE 235
City	:	DENVER
State	:	CO
Zip	:	80222-4305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 S BELLAIRE ST
Second Line	:	STE 235
City	:	DENVER
State	:	CO
Zip	:	80222-4305
Country	:	US
Telephone Number	:	303-756-3388
Fax Number	:	303-756-3399

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/29/2008

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Directions to “ ROBERT KANNAKA ” Practice Location

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