Basic Information
| Provider Information | |||||||||
| NPI: | 1962781484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GWIN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | SARAH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 S FRONTAGE RD W | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704761225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 142 EAST BEAVER CREEK BLD | ||||||||
| Address2: | UNIT 109 | ||||||||
| City: | AVON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703068609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2011 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6622 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.