Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8750 | CO |
NPI | 1053492074 |
---|---|
Provider Name | Karen S Vonderhaar |
First Address | Louisville, CO 80027-5003 |
Second Address | Westminster, CO 80021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A002 | TRICARE (01) | |
IMS67413 | BCBS (01) |