MEDICARE: MR. JON CHARLES WEST 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		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9624	OTHER	CO	CO LICENSE

General Provider Information

NPI Number	:	1215057351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON CHARLES WEST PT

Provider Business Mailing Address
First Line	:	356 S TAFT CT
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9510
Country	:	US
Telephone Number	:	720-339-5552
Fax Number	:	303-402-1665

Provider Business Practice Location Address
First Line	:	315 W SOUTH BOULDER RD
Second Line	:	#100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1156
Country	:	US
Telephone Number	:	303-601-6666
Fax Number	:	303-447-3390

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/20/2011

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