MEDICARE: MR. CASEY MCNITT 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	PTL.0008008	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTL.0008008	OTHER	CO	STATE OF COLORADO PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1790715027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CASEY MCNITT PT

Provider Business Mailing Address
First Line	:	800 N LINCOLN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2710
Country	:	US
Telephone Number	:	303-482-1540
Fax Number	:	303-482-1545

Provider Business Practice Location Address
First Line	:	800 N LINCOLN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2710
Country	:	US
Telephone Number	:	303-482-1540
Fax Number	:	303-482-1545

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/09/2016

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