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NPI Code Detail

MEDICARE: CARRIE UDY PTA

MEDICARE: CARRIE UDY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA.0013713CO

General Provider Information

NPI Number : 1194190603
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE UDY PTA
Provider Business Mailing Address
First Line : PO BOX 212
Second Line :
City : SEVERANCE
State : CO
Zip : 80546-0212
Country : US
Telephone Number : 970-302-0552
Fax Number :
Provider Business Practice Location Address
First Line : 1005 E ELIZABETH ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-3911
Country : US
Telephone Number : 970-482-5454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2015
Last Update Date : 01/15/2021

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