MEDICARE: MR. TIMOTHY JASON BERNACKI PT

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	8065	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154339281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY JASON BERNACKI PT

Provider Business Mailing Address
First Line	:	4284 TRAIL BOSS DR STE 130
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7521
Country	:	US
Telephone Number	:	303-663-8086
Fax Number	:	303-663-8289

Provider Business Practice Location Address
First Line	:	4284 TRAIL BOSS DR STE 130
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7521
Country	:	US
Telephone Number	:	303-663-8086
Fax Number	:	303-663-8289

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/23/2023

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Directions to “ MR. TIMOTHY JASON BERNACKI PT” Practice Location

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