Provider Demographics
NPI:1053532879
Name:CHADWICK, KRISANNA LIN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KRISANNA
Middle Name:LIN
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 PRAIRIE LARK LN
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8105
Mailing Address - Country:US
Mailing Address - Phone:970-405-3282
Mailing Address - Fax:
Practice Address - Street 1:5032 PRAIRIE LARK LN
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80615-8105
Practice Address - Country:US
Practice Address - Phone:970-405-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71902251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics