Healthcare Provider Details

I. General information

NPI: 1265770598
Provider Name (Legal Business Name): CAROLYN CHRISTIANO DIETER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE # 190
FRISCO CO
80443
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-0888
  • Fax:
Mailing address:
  • Phone: 970-624-4128
  • Fax: 970-490-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11771
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: