Provider Demographics
NPI:1861619694
Name:BOZICH, KIMBERLY ANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:BOZICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E COUNTY LINE RD
Mailing Address - Street 2:#A3
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-8102
Mailing Address - Country:US
Mailing Address - Phone:720-542-9712
Mailing Address - Fax:720-542-9831
Practice Address - Street 1:311 E COUNTY LINE RD
Practice Address - Street 2:#A3
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8102
Practice Address - Country:US
Practice Address - Phone:720-542-9712
Practice Address - Fax:720-542-9831
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0006983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCR003Medicare UPIN