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General NPI Number Information
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NPI Number | 1033521448
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Entity Type | Organization
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Legal Business Name | COLORADO LOW T ENTERPRISES LLC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 13550 NORTHGATE ESTATES DR SUITE 110
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-7653
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Country | US
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Telephone | 747-777-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 13550 NORTHGATE ESTATES DR SUITE 110
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-7653
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOSHUA ANDERSON
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Credential |
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Telephone | 747-777-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3066
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License Number State | CO
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