Provider Demographics
NPI:1609820174
Name:CARMELLINI, VINCENT PAUL (PT, DPT, OCS, MTC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:CARMELLINI
Suffix:
Gender:M
Credentials:PT, DPT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CODY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1240
Mailing Address - Country:US
Mailing Address - Phone:303-665-2405
Mailing Address - Fax:303-648-6602
Practice Address - Street 1:489 N US HIGHWAY 287 STE 190
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8905
Practice Address - Country:US
Practice Address - Phone:303-665-2405
Practice Address - Fax:306-648-6602
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90612251N0400X, 2251S0007X, 2251X0800X, 2251G0304X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9061OtherPHYSICAL THERAPIST
CO23770074Medicaid