Provider Demographics
NPI:1285780361
Name:CARRICO, ANN M (PT, MPT, CPED)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:CARRICO
Suffix:
Gender:F
Credentials:PT, MPT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SPRUCE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4716
Mailing Address - Country:US
Mailing Address - Phone:303-440-3359
Mailing Address - Fax:303-545-9527
Practice Address - Street 1:2400 SPRUCE ST STE 101
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4716
Practice Address - Country:US
Practice Address - Phone:303-440-3359
Practice Address - Fax:303-545-9527
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist