Healthcare Provider Details

I. General information

NPI: 1538683537
Provider Name (Legal Business Name): BRIAN TOLSMA CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 E GARDEN OF THE GODS RD STE 140
COLORADO SPRINGS CO
80907-4243
US

IV. Provider business mailing address

384 E GARDEN OF THE GODS RD STE 140
COLORADO SPRINGS CO
80907-4243
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-8198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO3173
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO3173
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: