MEDICARE: THE CENTER FOR SPORTS MEDICINE & REHABILITATION, PC

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	261QP2000X	Physical Therapy Clinic/Center		CO

General Provider Information

NPI Number	:	1457344319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR SPORTS MEDICINE & REHABILITATION, PC

Provider Business Mailing Address
First Line	:	100 PARK AVE
Second Line	:	SUITE 101
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-879-7799
Fax Number	:	970-879-1262

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:	SUITE 101
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-879-7799
Fax Number	:	970-879-1262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELISSA D BAUMGARTNER
Credential	:	M.S.P.T.
Telephone Number	:	970-879-7799

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	12/07/2007

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