Provider Demographics
NPI:1528549995
Name:CALDWELL, CARISSA ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:ANN
Other - Last Name:CLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3954 S WADSWORTH BLVD APT 310
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2248
Mailing Address - Country:US
Mailing Address - Phone:918-315-1227
Mailing Address - Fax:
Practice Address - Street 1:4500 E CHERRY CREEK SOUTH DR STE 710
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1534
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist