Healthcare Provider Details

I. General information

NPI: 1306548318
Provider Name (Legal Business Name): MARCIN SZCZYGLOWSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W. CACHE LA POUDRE STREET
COLORADO SPRINGS CO
80903
US

IV. Provider business mailing address

14 E CACHE LA POUDRE ST
COLORADO SPRINGS CO
80903-3243
US

V. Phone/Fax

Practice location:
  • Phone: 405-541-4367
  • Fax:
Mailing address:
  • Phone: 405-541-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTL.0018247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: