Provider Demographics
NPI:1962141192
Name:CARLEY, JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CARLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WILLOW VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3841
Mailing Address - Country:US
Mailing Address - Phone:143-523-2577
Mailing Address - Fax:
Practice Address - Street 1:550 W 465 N STE 504
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8014
Practice Address - Country:US
Practice Address - Phone:435-232-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016754225100000X
UT12746560-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist