Provider Demographics
NPI:1689291247
Name:CARLSON, KARISSA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 WADSWORTH BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-0918
Mailing Address - Country:US
Mailing Address - Phone:303-284-9875
Mailing Address - Fax:
Practice Address - Street 1:8410 WADSWORTH BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0918
Practice Address - Country:US
Practice Address - Phone:303-284-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist