Provider Demographics
NPI:1447815634
Name:SCALISI, CARLO M (PTA)
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:M
Last Name:SCALISI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:GRANT
Other - Middle Name:M
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1420 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4650
Mailing Address - Country:US
Mailing Address - Phone:970-458-4226
Mailing Address - Fax:970-522-4818
Practice Address - Street 1:1420 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4650
Practice Address - Country:US
Practice Address - Phone:970-458-4226
Practice Address - Fax:970-522-4818
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant