1528549995 NPI number — CARISSA ANN CALDWELL PT, DPT

Table of content: CARISSA ANN CALDWELL PT, DPT (NPI 1528549995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528549995 NPI number — CARISSA ANN CALDWELL PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
CARISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLUCK
Provider Other First Name:
CARISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528549995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3954 S WADSWORTH BLVD APT 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80235-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-315-1227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 E CHERRY CREEK SOUTH DR STE 710
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80246-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-432-8487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTL.0015922 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)