Healthcare Provider Details

I. General information

NPI: 1326651498
Provider Name (Legal Business Name): CHRISTOPHER M JUNEAU PT, DPT, SCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US AIR FORCE/ FORT CARSON 8420 SKYRAIDER RD
COLORADO SPRINGS AA
80913
US

IV. Provider business mailing address

1340 FARNHAM PT APT 208
COLORADO SPRINGS CO
80904-5202
US

V. Phone/Fax

Practice location:
  • Phone: 318-715-8415
  • Fax:
Mailing address:
  • Phone: 318-715-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTL.0017179
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: