Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070015931 | IL |
Y | 225100000X | Physical Therapist | PTL.0012104 | CO |
NPI | 1003000829 |
---|---|
Provider Name | Michelle Renee Kochanek |
First Address | Denver, CO 80222-3311 |
Second Address | Denver, CO 80222-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 01/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01622333 | BLUE CROSS BLUE SHIELD ID (01) | |
7454077 | AETNA (01) |