Healthcare Provider Details

I. General information

NPI: 1477947943
Provider Name (Legal Business Name): CHARLENE PERKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-5748
US

IV. Provider business mailing address

4124 SHELBE CT
COLORADO SPRINGS CO
80911-5208
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-8884
  • Fax:
Mailing address:
  • Phone: 719-761-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT.0017413
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: