Provider Demographics
NPI:1104278480
Name:DIFLUMERI, CARRIE (MPT)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:DIFLUMERI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 SKUNK ALY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6833
Mailing Address - Country:US
Mailing Address - Phone:303-518-0439
Mailing Address - Fax:
Practice Address - Street 1:7027 SKUNK ALY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-6833
Practice Address - Country:US
Practice Address - Phone:303-518-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6799OtherSTATE OF COLORADO, DEPT OF REGULATORY AGENCIES, P.T LICENSE