Healthcare Provider Details

I. General information

NPI: 1679523690
Provider Name (Legal Business Name): BANBA RUTH SWICKER-LIPTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 N ACADEMY BLVD
COLORADO SPRINGS CO
80917-5310
US

IV. Provider business mailing address

3090 N ACADEMY BLVD
COLORADO SPRINGS CO
80917-5310
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-8300
  • Fax: 719-574-9547
Mailing address:
  • Phone: 719-574-8300
  • Fax: 719-574-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1947
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1947
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: