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General NPI Number Information
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NPI Number | 1508816208
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Entity Type | Organization
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Legal Business Name | JERRY NEWMAN PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 902 MAIN ST
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City | FORT MORGAN
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State | CO
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Zip | 80701-2032
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Country | US
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Telephone | 970-867-6493
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Fax | 970-867-5426
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Provider Business Mailing Address
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Address Line | 902 MAIN ST
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City | FORT MORGAN
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State | CO
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Zip | 80701-2032
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Country | US
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Telephone | 970-867-6493
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Fax | 970-867-5426
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD K NEWMAN
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Credential | PT
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Telephone | 970-867-6493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4453
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License Number State | CO
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