MEDICARE: TAKE CHARGE PHYSICAL THERAPY, PLLC

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	261QP2000X	Physical Therapy Clinic/Center	2201	CO

General Provider Information

NPI Number	:	1154662591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKE CHARGE PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	17110 MITCHELL AVE
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8156
Country	:	US
Telephone Number	:	719-651-2447
Fax Number	:	719-488-6547

Provider Business Practice Location Address
First Line	:	325 SECOND ST STE O
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7935
Country	:	US
Telephone Number	:	719-481-3747
Fax Number	:	719-488-6547

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	MRS. KANDRA KAY LOVATO
Credential	:	P.T
Telephone Number	:	719-651-2447

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	03/11/2013

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