Provider Demographics
NPI:1619167475
Name:EMMONS, CAROL JO (CPTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JO
Last Name:EMMONS
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JO
Other - Last Name:EMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPTA
Mailing Address - Street 1:520 S HARRISON LN
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3517
Mailing Address - Country:US
Mailing Address - Phone:303-908-2325
Mailing Address - Fax:
Practice Address - Street 1:3185 W ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4004
Practice Address - Country:US
Practice Address - Phone:303-922-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400890225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant