Healthcare Provider Details

I. General information

NPI: 1497713705
Provider Name (Legal Business Name): CAROLYN ANN WELLS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 E 19TH AVE
DENVER CO
80218-1007
US

IV. Provider business mailing address

7460 E LOWRY BLVD
DENVER CO
80230-7003
US

V. Phone/Fax

Practice location:
  • Phone: 303-837-2589
  • Fax:
Mailing address:
  • Phone: 303-837-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number740
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: