Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 037416 | NY |
Y | 2251S0007X | Physical Therapist - Sports | PTL.0013928 | CO |
NPI | 1104363787 |
---|---|
Provider Name | Kaitlyn Flynn |
First Address | Parker, CO 80138-8506 |
Second Address | Parker, CO 80138-8506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 20/01/2017 |