Individual
KIMBERLY R DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC, CSCS
Contact information
Practice address
2150 STADIUM DRIVE, BOULDER, CO 80309-7059
(512) 230-6171
Mailing address
1166 OPAL ST UNIT 102, BROOMFIELD, CO 80020-7059
(512) 230-6171
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0001754
CO
Other
Enumeration date
04/17/2006
Last updated
04/09/2019
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