MEDICARE: MS. VICKY L BLEDSOE PT

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	2251X0800X	Orthopedic Physical Therapist	1098267	TX
2	225100000X	Physical Therapist	0016503	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T0929	OTHER	TX	BCBS INDIVIDUAL NUMBER

General Provider Information

NPI Number	:	1336142546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKY L BLEDSOE PT

Provider Business Mailing Address
First Line	:	1939 WILMINGTON DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6404
Country	:	US
Telephone Number	:	970-377-1442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 WILMINGTON DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6404
Country	:	US
Telephone Number	:	970-377-1442
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/28/2021

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