Healthcare Provider Details

I. General information

NPI: 1669549382
Provider Name (Legal Business Name): CARLA ANN HABUDA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 E 6TH AVE
DENVER CO
80206-4550
US

IV. Provider business mailing address

3738 E 6TH AVE
DENVER CO
80206-4550
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-5856
  • Fax:
Mailing address:
  • Phone: 303-333-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5975
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: