MEDICARE: CHARLES REAGAN TOAL PT, DPT

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	PT61675054	WA
2	225100000X	Physical Therapist	305820	CA
3	225100000X	Physical Therapist	PTL.0020907	CO

General Provider Information

NPI Number	:	1104531672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES REAGAN TOAL PT, DPT

Provider Business Mailing Address
First Line	:	15746 JACKSON CREEK PKWY STE B
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7183
Country	:	US
Telephone Number	:	719-481-0899
Fax Number	:	719-481-0897

Provider Business Practice Location Address
First Line	:	15746 JACKSON CREEK PKWY STE B
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7183
Country	:	US
Telephone Number	:	719-481-0899
Fax Number	:	719-481-0897

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

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	03/03/2026

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