Healthcare Provider Details

I. General information

NPI: 1619212909
Provider Name (Legal Business Name): GLORIE CATARISANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N NEVADA AVE
COLORADO SPRINGS CO
80903-2472
US

IV. Provider business mailing address

1215 N NEVADA AVE
COLORADO SPRINGS CO
80903-2472
US

V. Phone/Fax

Practice location:
  • Phone: 719-440-6789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0012707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: