Healthcare Provider Details

I. General information

NPI: 1124575287
Provider Name (Legal Business Name): LAKSHMANAN ARUMUGAM P.T.ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAKSHMANAN ARUMUGAM P.T.ASSISTANT

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 VINDICATOR DR SUITE 105
COLORADO SPRINGS CO
80919-3623
US

IV. Provider business mailing address

120.WEST VAN BUREN STREET APT # 16
COLORADO SPRINGS CO
80907
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-6605
  • Fax:
Mailing address:
  • Phone: 810-569-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 0012044
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: