Healthcare Provider Details

I. General information

NPI: 1457662488
Provider Name (Legal Business Name): KATIE ANN CARLSON R.P.T.A. , LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIR STE 207
CENTENNIAL CO
80112-1145
US

IV. Provider business mailing address

11886 BARRETT ST
PARKER CO
80138-8011
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-3600
  • Fax:
Mailing address:
  • Phone: 620-212-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02081
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: