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General NPI Number Information
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NPI Number | 1821426867
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Entity Type | Individual
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Provider Name | CARRIE LYNE M MATHIESEN DPT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4328 AUSTIN BLUFFS PKWY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-2932
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Country | US
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Telephone | 719-475-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 DALLAS PKWY STE 290
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City | FRISCO
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State | TX
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Zip | 75034-7493
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Country | US
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Telephone | 945-260-0010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 070.020366
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTL.0012475
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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