Individual
KYLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
590 BURBANK ST UNIT 205, BROOMFIELD, CO 80020-7171
(303) 460-0329
(303) 460-0387
Mailing address
590 BURBANK ST UNIT 205, BROOMFIELD, CO 80020-7171
(303) 460-0329
(303) 460-0387
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0015529
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA.0015529
COLORADO SATE LICENSE
CO
Enumeration date
07/15/2024
Last updated
07/15/2024
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