Provider Demographics
NPI:1013456540
Name:DECARLO, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DECARLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 STADIUM DR
Mailing Address - Street 2:CU ATHLETICS, 368 UCB
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0001
Mailing Address - Country:US
Mailing Address - Phone:303-735-7121
Mailing Address - Fax:
Practice Address - Street 1:2150 STADIUM DR
Practice Address - Street 2:CU ATHLETICS, 368 UCB
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0001
Practice Address - Country:US
Practice Address - Phone:303-735-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00016102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer