MEDICARE: REGIONAL PHYSICAL THERAPY

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	2115	CO

General Provider Information

NPI Number	:	1932321411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6165 LEHMAN DR
Second Line	:	STE 102
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-5405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6165 LEHMAN DR
Second Line	:	STE 102
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-5405
Country	:	US
Telephone Number	:	719-264-8524
Fax Number	:	719-264-8526

Authorized Official
Title or Position	:	COOWNERPHYSICALTHERAPIST
Name	:	CARMEN SMITH
Credential	:
Telephone Number	:	719-264-8524

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/18/2008

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Directions to “REGIONAL PHYSICAL THERAPY ” Practice Location

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