MEDICARE: LIFE WHEELS ON PC

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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1144821547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE WHEELS ON PC

Provider Business Mailing Address
First Line	:	PO BOX 753
Second Line	:
City	:	GREEN MOUNTAIN FALLS
State	:	CO
Zip	:	80819-0753
Country	:	US
Telephone Number	:	719-331-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4410
Country	:	US
Telephone Number	:	719-331-1011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA MORGAN
Credential	:
Telephone Number	:	719-331-1011

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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Directions to “LIFE WHEELS ON PC ” Practice Location

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