MEDICARE: MR. ROBERT JAMES PACKARD PTA

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	225200000X	Physical Therapy Assistant	NA	CO

General Provider Information

NPI Number	:	1073719316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAMES PACKARD PTA

Provider Business Mailing Address
First Line	:	1371 E HECLA DR
Second Line	:	SUITE E
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2327
Country	:	US
Telephone Number	:	303-665-6064
Fax Number	:

Provider Business Practice Location Address
First Line	:	1371 E HECLA DR
Second Line	:	SUITE E
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2327
Country	:	US
Telephone Number	:	303-665-6064
Fax Number	:

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

Provider Enumeration Date	:	06/24/2007
Last Update Date	:	07/31/2007

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