Individual
KHUMBO TAKURA SIPIRIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPTA
Contact information
Practice address
8301 E PRENTICE AVE, GREENWOOD VILLAGE, CO 80111-2903
(303) 322-8300
Mailing address
3886 EAGLE TAIL LN, CASTLE ROCK, CO 80104-7925
(720) 251-9411
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0014112
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA.0014112
COLORADO DIVISION OF PROFESSIONS AND OCCUPATIONS
CO
Enumeration date
10/18/2018
Last updated
10/18/2018
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