MEDICARE: MR. JASON ROSIN CMT

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	174400000X	Specialist

General Provider Information

NPI Number	:	1083745699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON ROSIN CMT

Provider Business Mailing Address
First Line	:	3938 JOHN F KENNEDY PKWY
Second Line	:	SUITE 11-F
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3086
Country	:	US
Telephone Number	:	970-204-0516
Fax Number	:	970-204-6812

Provider Business Practice Location Address
First Line	:	3938 JOHN F KENNEDY PKWY
Second Line	:	SUITE 11-F
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3086
Country	:	US
Telephone Number	:	970-204-0516
Fax Number	:	970-204-6812

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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