Healthcare Provider Details

I. General information

NPI: 1083148068
Provider Name (Legal Business Name): JOSEPH PADILLA II DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W BIJOU ST
COLORADO SPRINGS CO
80905-1309
US

IV. Provider business mailing address

402 W BIJOU ST
COLORADO SPRINGS CO
80905-1309
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-5518
  • Fax: 719-634-1455
Mailing address:
  • Phone: 719-634-5518
  • Fax: 719-634-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0014688
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: