MEDICARE: MRS. SARAH JANE SPILLER MSPT

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	0010599	CO

General Provider Information

NPI Number	:	1053651513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH JANE SPILLER MSPT

Provider Business Mailing Address
First Line	:	5013 HORSE CARRIAGE RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5013 HORSE CARRIAGE RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2345
Country	:	US
Telephone Number	:	413-214-3480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	02/20/2013

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