Basic Information
| Provider Information | |||||||||
| NPI: | 1619167475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMMONS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | CPTA | ||||||||
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| OtherLastName: | EMMONS | ||||||||
| OtherFirstName: | CAROL | ||||||||
| OtherMiddleName: | JO | ||||||||
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| OtherCredential: | CPTA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 520 S HARRISON LN | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802093517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039082325 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3185 W ARKANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802194004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039221169 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1400890 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.