MEDICARE: COLORADO INJURY TREATMENT CENTER PROFESSIONAL COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1053559047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO INJURY TREATMENT CENTER PROFESSIONAL COMPANY

Provider Business Mailing Address
First Line	:	1330 S POTOMAC ST STE 100
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4527
Country	:	US
Telephone Number	:	303-745-0803
Fax Number	:	720-306-3758

Provider Business Practice Location Address
First Line	:	1330 S POTOMAC ST STE 100
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4527
Country	:	US
Telephone Number	:	303-745-0803
Fax Number	:	720-306-3758

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	DR. JAIME LYNN SWANSON
Credential	:	DPT
Telephone Number	:	303-745-0803

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	05/13/2022

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