Provider Demographics
NPI:1770512352
Name:STELLICK, KAREN WENNING (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WENNING
Last Name:STELLICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JOSEPHINE
Other - Last Name:WENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1775 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1926
Mailing Address - Country:US
Mailing Address - Phone:719-477-6870
Mailing Address - Fax:719-477-1483
Practice Address - Street 1:1775 S 8TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1926
Practice Address - Country:US
Practice Address - Phone:719-477-6870
Practice Address - Fax:719-477-1483
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO551658Medicare ID - Type Unspecified