Basic Information
| Provider Information | |||||||||
| NPI: | 1467489401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYWHORT | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | RAE | ||||||||
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| OtherLastName: | GEORGE | ||||||||
| OtherFirstName: | KERI | ||||||||
| OtherMiddleName: | RAE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10200 PARK MEADOWS DR | ||||||||
| Address2: | #1714 | ||||||||
| City: | LONETREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202205499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7340 S ALTON WAY | ||||||||
| Address2: | STE 11-D | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801122335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204931181 | ||||||||
| FaxNumber: | 7204931191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6727 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.