Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7190 | CO |
N | 2251P0200X | Physical Therapist - Pediatrics | 7190 | CO |
NPI | 1053532879 |
---|---|
Provider Name | Mrs. Krisanna Lin Chadwick |
First Address | Severance, CO 80615-8105 |
Second Address | Severance, CO 80615-8105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 30/07/2020 |