Healthcare Provider Details

I. General information

NPI: 1023654720
Provider Name (Legal Business Name): CARRISSA SHEA ERDELY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E CHEYENNE MOUNTAIN BLVD STE N
COLORADO SPRINGS CO
80906-3769
US

IV. Provider business mailing address

202 E CHEYENNE MOUNTAIN BLVD STE N
COLORADO SPRINGS CO
80906-3769
US

V. Phone/Fax

Practice location:
  • Phone: 719-533-1318
  • Fax: 719-533-1319
Mailing address:
  • Phone: 719-533-1318
  • Fax: 719-533-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0016718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: