Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTL.0014738 | CO |
Y | 213ES0000X | Sports Medicine | PTL.0014738 | CO |
NPI | 1083136329 |
---|---|
Provider Name | Katherine Olivia Weigand |
First Address | Boulder, CO 80301-3754 |
Second Address | Vail, CO 81657-5242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 19/02/2020 |