Provider Demographics
NPI:1053617167
Name:CARNES, CARLA RAE (PT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RAE
Last Name:CARNES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3350
Mailing Address - Country:US
Mailing Address - Phone:719-846-7754
Mailing Address - Fax:
Practice Address - Street 1:323 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2611
Practice Address - Country:US
Practice Address - Phone:719-846-6886
Practice Address - Fax:719-846-8629
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-9504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist