Provider Demographics
NPI:1487104782
Name:HARDY, CARMEN (PTA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 S GREENING DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6080 W 92ND AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2928
Practice Address - Country:US
Practice Address - Phone:303-427-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013405225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant