Active NPI
Kimberly Dennis
- Physical Therapy Assistant
- Pagosa Springs, CO
National Provider Identifier
1497091763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 12802
- Practice address
- 119 Bastille Dr
Pagosa Springs, CO 81147-9388 - Phone
- (970) 731-4330
- NPI assigned
- Dec 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 12802 | CO | Primary |
Addresses
Primary practice location
119 Bastille Dr
Pagosa Springs, CO 81147-9388
Mailing address
108 Gala PL
Pagosa Springs, CO 81147-9156
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12802 | CO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355443200000",
"number": "1497091763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 GALA PL",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "811479156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 BASTILLE DR",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "811479388",
"telephone_number": "970-731-4330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNIS",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-14",
"last_updated": "2012-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "12802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pagosa Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.