Provider Demographics
NPI:1518343565
Name:CALDERON, DARLA
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 OUTLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1388
Mailing Address - Country:US
Mailing Address - Phone:719-568-9848
Mailing Address - Fax:719-368-8387
Practice Address - Street 1:5055 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1388
Practice Address - Country:US
Practice Address - Phone:719-568-9848
Practice Address - Fax:719-368-8387
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012787225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant