Healthcare Provider Details

I. General information

NPI: 1427681964
Provider Name (Legal Business Name): TOLSMA STOCKWELL PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 E GARDEN OF THE GODS RD STE 140
COLORADO SPRINGS CO
80907-4243
US

IV. Provider business mailing address

384 E GARDEN OF THE GODS RD STE 140
COLORADO SPRINGS CO
80907-4243
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-8198
  • Fax:
Mailing address:
  • Phone: 719-301-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SCOTT TOLSMA
Title or Position: CLINICAL DIRECTOR
Credential: CPO
Phone: 719-301-8198