Provider Demographics
NPI:1134342694
Name:KAUTZ, JEFFREY ALLEN (PT,ATC,CSCS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:KAUTZ
Suffix:
Gender:M
Credentials:PT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1656
Mailing Address - Country:US
Mailing Address - Phone:303-457-2022
Mailing Address - Fax:303-457-2320
Practice Address - Street 1:3724 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1656
Practice Address - Country:US
Practice Address - Phone:303-457-2022
Practice Address - Fax:303-457-2320
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9217208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26589524Medicaid
CO26589524Medicaid