Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10532 | CO |
N | 225700000X | Massage Therapist | ||
N | 226300000X | Kinesiotherapist |
NPI | 1629308044 |
---|---|
Provider Name | Dr. John Alexander Kummrow |
First Address | Fort Collins, CO 80525 |
Second Address | Fort Collins, CO 80525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2010 |
Last Update Date | 08/01/2019 |