Healthcare Provider Details

I. General information

NPI: 1508093279
Provider Name (Legal Business Name): MELANIE DIANE LAMBERT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE DIANE BERRY

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 TELSTAR DR STE 115
COLORADO SPRINGS CO
80920-1029
US

IV. Provider business mailing address

600 S 21ST ST UNIT 130
COLORADO SPRINGS CO
80904-3763
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1110
  • Fax: 719-634-1112
Mailing address:
  • Phone: 719-634-1110
  • Fax: 719-634-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberT-02421
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number13665
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0019649
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: