Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 9061 | CO |
N | 2251H1200X | Hand | 9061 | CO |
N | 2251N0400X | Physical Therapist - Neurology | 9061 | CO |
N | 2251S0007X | Physical Therapist - Sports | 9061 | CO |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9061 | CO |
NPI | 1609820174 |
---|---|
Provider Name | Dr. Vincent Paul Carmellini |
First Address | Lakewood, CO 80226-1240 |
Second Address | Lafayette, CO 80026-8905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23770074 | (05) | CO |
9061 | PHYSICAL THERAPIST (01) | CO |