MEDICARE: RALPH BIDWELL P.T.

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	4345	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B085701	OTHER	CO	IHP PROVIDER ID#

General Provider Information

NPI Number	:	1306966221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH BIDWELL P.T.

Provider Business Mailing Address
First Line	:	6440 WHIRLWIND DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7542
Country	:	US
Telephone Number	:	719-266-1101
Fax Number	:	719-266-1101

Provider Business Practice Location Address
First Line	:	4386 TRAIL BOSS DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-8666
Fax Number	:	303-688-8260

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	01/20/2026

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