Provider Demographics
NPI:1053863746
Name:EMERSON, CHARLES (PA, ATC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:EMERSON
Suffix:
Gender:M
Credentials:PA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-1103
Mailing Address - Fax:970-490-4156
Practice Address - Street 1:11820 DESTINATION DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-2518
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:303-460-6197
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT97201363A00000X
FLPA9109426363A00000X
COPA.0008875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant