MEDICARE: DAVID ABBOTT NMT HMS SMT LMT TIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	225700000X	Massage Therapist	MT.0019317	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	708340	OTHER	CO	AVAILITY

General Provider Information

NPI Number	:	1245738970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ABBOTT NMT HMS SMT LMT TIC

Provider Business Mailing Address
First Line	:	2120 ACADEMY CIR STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1674
Country	:	US
Telephone Number	:	719-373-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 ACADEMY CIR STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1674
Country	:	US
Telephone Number	:	719-373-3399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	10/05/2022

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