MEDICARE: JONATHAN BROWN PTL

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	00000	CO
2	225100000X	Physical Therapist	11601	CO

General Provider Information

NPI Number	:	1205102605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN BROWN PTL

Provider Business Mailing Address
First Line	:	2140 HOLLOW BROOK DR
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1452
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 HOLLOW BROOK DR
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1452
Country	:	US
Telephone Number	:	719-596-5000
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	04/06/2012

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