Healthcare Provider Details

I. General information

NPI: 1306241161
Provider Name (Legal Business Name): BRITTNY CAJACOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7120
  • Fax:
Mailing address:
  • Phone: 719-526-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12908-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13053
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: