Healthcare Provider Details

I. General information

NPI: 1154014173
Provider Name (Legal Business Name): BRETT T LOZON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 E CHEYENNE MOUNTAIN BLVD
COLORADO SPRINGS CO
80906-4027
US

IV. Provider business mailing address

9070 W CHEYENNE AVE STE 100
LAS VEGAS NV
89129-8935
US

V. Phone/Fax

Practice location:
  • Phone: 719-527-0848
  • Fax: 719-527-0838
Mailing address:
  • Phone: 702-818-5000
  • Fax: 702-818-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0019145
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: