Healthcare Provider Details

I. General information

NPI: 1780302687
Provider Name (Legal Business Name): INGRID ROSE CARLSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR STE 190
FRISCO CO
80443-5868
US

IV. Provider business mailing address

2472 PATTERSON RD UNIT 8
GRAND JUNCTION CO
81505-1100
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-0888
  • Fax: 970-668-0227
Mailing address:
  • Phone: 970-241-0202
  • Fax: 970-245-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018611
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: