Basic Information
| Provider Information | |||||||||
| NPI: | 1568460392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLEARY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | O'LEARY | ||||||||
| OtherFirstName: | KASEY | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3000 CENTER GREEN DR | ||||||||
| Address2: | 110 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036016666 | ||||||||
| FaxNumber: | 3034473390 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 CENTER GREEN DR | ||||||||
| Address2: | 110 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036016666 | ||||||||
| FaxNumber: | 3034473390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6803 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6803 | 01 | CO | PHYSICAL THERAPY LICENSE | OTHER |