Provider Demographics
NPI:1871088450
Name:KAZIBUT, KAREN DIANE (DPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:KAZIBUT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MITTLEFEHLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 200880
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0880
Mailing Address - Country:US
Mailing Address - Phone:678-837-7176
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:1500 LITTLE RAVEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6248
Practice Address - Country:US
Practice Address - Phone:720-360-4519
Practice Address - Fax:720-251-4888
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist