Healthcare Provider Details

I. General information

NPI: 1992028856
Provider Name (Legal Business Name): JEFFREY WILLARD NEWMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 STAR RANCH RD
COLORADO SPRINGS CO
80906-7660
US

IV. Provider business mailing address

4715 STAR RANCH RD
COLORADO SPRINGS CO
80906-7660
US

V. Phone/Fax

Practice location:
  • Phone: 719-527-0669
  • Fax: 719-527-9893
Mailing address:
  • Phone: 719-527-0669
  • Fax: 719-527-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1018646
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2406
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1018646
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1018646
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2406
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: