Healthcare Provider Details

I. General information

NPI: 1720157258
Provider Name (Legal Business Name): NORTHSTAR PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 HOLLOW BROOK DR
COLORADO SPRINGS CO
80918-1444
US

IV. Provider business mailing address

2180 HOLLOW BROOK DR
COLORADO SPRINGS CO
80918-1444
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-5862
  • Fax:
Mailing address:
  • Phone: 719-599-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEWIS
Title or Position: OWNER
Credential:
Phone: 719-599-5862