Individual provider Active NPI

Kayla Dean Bousfield

  • Physical Therapist
  • Commerce City, CO
National Provider Identifier
1912583105
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL.0018606 Issued in CO
Practice address
13659 E 104TH Ave Unit 300
Commerce City, CO 80022-9402
Phone
(720) 506-5340
NPI assigned
Mar 19, 2021
Last updated
Dec 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15369-24 WI
Physical Therapist 225100000X 040-0134255 VT
Physical Therapist 225100000X 28700 MD
Physical Therapist 225100000X PTL.0018606 CO Primary

Addresses

Primary practice location

13659 E 104TH Ave Unit 300
Commerce City, CO 80022-9402

Mailing address

15 Grandview Acres
Glenburn, ME 04401-1038
Phone (207) 478-4858

Other practice location 1

15 Grandview Acres
Glenburn, ME 04401-1038
Phone (207) 478-4858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221003000555 CO Practitioner - Physical Therapist in Private Practice 6800284779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL.0018606COMDPhysical Therapist
28700MDMDPhysical Therapist
040-0134255VTMDPhysical Therapist
15369-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MVP Physical Therapy, LLC Physical Therapist CurrentSince Dec 28, 2022 Accepting new patients
Select Physical Therapy of West Denver Limited Partnership CurrentSince Sep 1, 2022 Accepting new patients
Select Physical Therapy of West Denver Limited Partnership PastSince Aug 18, 2019 Accepting new patients

Locations

13659 E 104th Ave
Ste 300400
Commerce City, CO 80022
Phone (702) 506-5340

13659 E 104th Ave
Unit 300
Commerce City, CO 80022
Phone (720) 506-5340

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1912583105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GRANDVIEW ACRES",
            "city": "GLENBURN",
            "state": "ME",
            "postal_code": "044011038",
            "telephone_number": "207-478-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13659 E 104TH AVE UNIT 300",
            "city": "COMMERCE CITY",
            "state": "CO",
            "postal_code": "800229402",
            "telephone_number": "720-506-5340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Grandview Acres",
            "address_purpose": "LOCATION",
            "city": "Glenburn",
            "state": "ME",
            "postal_code": "044011038",
            "country_code": "US",
            "telephone_number": "207-478-4858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUSFIELD",
        "first_name": "KAYLA",
        "middle_name": "DEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-19",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15369-24",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040-0134255",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28700",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0018606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commerce City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.