Provider Demographics
NPI:1114245586
Name:CAROL THIELE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CAROL THIELE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-673-0778
Mailing Address - Street 1:516 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1920
Mailing Address - Country:US
Mailing Address - Phone:303-673-0778
Mailing Address - Fax:
Practice Address - Street 1:300 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8247
Practice Address - Country:US
Practice Address - Phone:303-729-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty