Provider Demographics
NPI:1457662488
Name:CARLSON, KATIE ANN (RPTA , LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RPTA , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11886 BARRETT ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8011
Mailing Address - Country:US
Mailing Address - Phone:620-212-3533
Mailing Address - Fax:
Practice Address - Street 1:6881 S HOLLY CIR STE 207
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1145
Practice Address - Country:US
Practice Address - Phone:303-221-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02081225200000X
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant