Healthcare Provider Details

I. General information

NPI: 1346154531
Provider Name (Legal Business Name): WILD ROOT PHYSIOTHERAPY & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 POLK CIR W
WELLINGTON CO
80549-1681
US

IV. Provider business mailing address

3440 POLK CIR W
WELLINGTON CO
80549-1681
US

V. Phone/Fax

Practice location:
  • Phone: 970-980-5534
  • Fax:
Mailing address:
  • Phone: 970-980-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINDSEY KARLIN
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: DPT
Phone: 970-980-5534