Individual
MARK KINCAID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0016848
CO
225100000X
Physical Therapist
Primary
PTL.0016848
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTL.0016848
PHYSICAL THERAPY LICENSE
CO
Enumeration date
03/04/2020
Last updated
11/17/2020
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