Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 12813 | CO |
N | 225200000X | Physical Therapy Assistant | 14-02337 | KS |
NPI | 1013272384 |
---|---|
Provider Name | Justin Tyler Kutz |
First Address | Denver, CO 80237-3490 |
Second Address | Denver, CO 80237-3490 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 11/07/2012 |