Healthcare Provider Details

I. General information

NPI: 1134565195
Provider Name (Legal Business Name): SUNDAY LEE CARAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-2517
US

IV. Provider business mailing address

940 ROBBIE VW APT 1725
COLORADO SPRINGS CO
80920-3284
US

V. Phone/Fax

Practice location:
  • Phone: 316-390-6624
  • Fax: 719-313-9072
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0010388
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: