Healthcare Provider Details

I. General information

NPI: 1366360489
Provider Name (Legal Business Name): WORKTIME ATHLETIC PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 BRIARGATE BLVD STE 100
COLORADO SPRINGS CO
80920-3450
US

IV. Provider business mailing address

7105 HORIZON WOOD LN
COLORADO SPRINGS CO
80927-4117
US

V. Phone/Fax

Practice location:
  • Phone: 719-433-4759
  • Fax:
Mailing address:
  • Phone: 719-433-4759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM IVAN JACKSON III
Title or Position: SENIOR CLINICIAN
Credential: DAT
Phone: 719-433-4759