Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTL.0001914 | CO |
N | 2251S0007X | Physical Therapist - Sports | PTL.0001914 | CO |
NPI | 1386701548 |
---|---|
Provider Name | Carol Ann Thiele |
First Address | Boulder, CO 80301-2709 |
Second Address | Boulder, CO 80309-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 10/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
98807226 | (05) | CO |