Provider Demographics
NPI:1336198688
Name:MATTER, CARRIE S (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:S
Last Name:MATTER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-940-1611
Mailing Address - Fax:303-432-2296
Practice Address - Street 1:3257 W 116TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7135
Practice Address - Country:US
Practice Address - Phone:303-465-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7462174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO461198Medicare PIN