Provider Demographics
NPI:1902041064
Name:PETT, KAREN LOUISE (LMT CNMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:PETT
Suffix:
Gender:F
Credentials:LMT CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4199
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-4199
Mailing Address - Country:US
Mailing Address - Phone:719-686-0142
Mailing Address - Fax:719-686-0142
Practice Address - Street 1:602 W MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1086
Practice Address - Country:US
Practice Address - Phone:719-686-0142
Practice Address - Fax:719-686-0142
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO707893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist