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General NPI Number Information
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NPI Number | 1366360489
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Entity Type | Organization
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Legal Business Name | WORKTIME ATHLETIC PERFORMANCE
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 1710 BRIARGATE BLVD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3450
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Country | US
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Telephone | 719-433-4759
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Fax |
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Provider Business Mailing Address
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Address Line | 7105 HORIZON WOOD LN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80927-4117
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Country | US
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Telephone | 719-433-4759
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Fax |
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Authorized Official
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Title or Position | SENIOR CLINICIAN
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Name | DR. WILLIAM IVAN JACKSON III
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Credential | DAT
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Telephone | 719-433-4759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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