Individual
CHARLIE MERRILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1790 30TH ST, SUITE 314, BOULDER, CO 80301-1022
(303) 444-8707
(303) 444-8109
Mailing address
459 GOLD RUN RD, BOULDER, CO 80302-9762
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
261QP2000X CO
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7010
PT LICENSE NUMBER
CO
Enumeration date
12/12/2006
Last updated
07/08/2007
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