Provider Demographics
NPI:1124705595
Name:DAMITOG, CAROLINE LEWIS-STIEGLITZ (ATC, LAT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LEWIS-STIEGLITZ
Last Name:DAMITOG
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:VICTORIA
Other - Last Name:LEWIS-STIEGLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1100 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3122
Mailing Address - Country:US
Mailing Address - Phone:970-248-1548
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3122
Practice Address - Country:US
Practice Address - Phone:970-248-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-4765207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine