Provider Demographics
NPI:1821430406
Name:PRINSLOW, CARLEE
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:PRINSLOW
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 1:32517 COUNTY ROAD 33
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:CO
Mailing Address - Zip Code:80117-8919
Mailing Address - Country:US
Mailing Address - Phone:303-877-1320
Mailing Address - Fax:
Practice Address - Street 1:32517 COUNTY ROAD 33
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:CO
Practice Address - Zip Code:80117-8919
Practice Address - Country:US
Practice Address - Phone:303-877-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA0013206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant