Provider Demographics
NPI:1336198076
Name:LAURSEN, CARLTON G (PT)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:G
Last Name:LAURSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 S ALTON WAY
Mailing Address - Street 2:STE 6L
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2334
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:720-488-1988
Practice Address - Street 1:900 CASTLETON RD
Practice Address - Street 2:#100
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-7552
Practice Address - Country:US
Practice Address - Phone:303-688-3914
Practice Address - Fax:303-688-4499
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 3195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO445338Medicare PIN