MEDICARE: ERICA LEE FREEMAN DPT, ATC

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	225100000X	Physical Therapist	PTL-10827	CO

General Provider Information

NPI Number	:	1306158647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LEE FREEMAN DPT, ATC

Provider Business Mailing Address
First Line	:	4105 BRIARGATE PKWY
Second Line	:	SUITE 255
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3480
Country	:	US
Telephone Number	:	719-282-2320
Fax Number	:	719-282-2330

Provider Business Practice Location Address
First Line	:	4105 BRIARGATE PKWY
Second Line	:	SUITE 255
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3480
Country	:	US
Telephone Number	:	719-282-2320
Fax Number	:	719-282-2330

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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