Provider Demographics
NPI:1235276338
Name:UNGER, CARYN STANWYCK (MS, PT)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:STANWYCK
Last Name:UNGER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2237
Mailing Address - Country:US
Mailing Address - Phone:970-691-1223
Mailing Address - Fax:970-377-1690
Practice Address - Street 1:1111 LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2237
Practice Address - Country:US
Practice Address - Phone:970-691-1223
Practice Address - Fax:970-377-1690
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2959225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43074006Medicaid