1568460392 NPI number — KATHERINE E OLEARY PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568460392 NPI number — KATHERINE E OLEARY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLEARY
Provider First Name:
KATHERINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'LEARY
Provider Other First Name:
KASEY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568460392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 CENTER GREEN DR
Provider Second Line Business Mailing Address:
110
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-601-6666
Provider Business Mailing Address Fax Number:
303-447-3390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CENTER GREEN DR
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-601-6666
Provider Business Practice Location Address Fax Number:
303-447-3390
Provider Enumeration Date:
07/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6803 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6803 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".