MEDICARE: CHRISTOPHER M JUNEAU PT, DPT, SCS, CSCS

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	2251S0007X	Sports Physical Therapist	PTL.0017179	CO

General Provider Information

NPI Number	:	1326651498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER M JUNEAU PT, DPT, SCS, CSCS

Provider Business Mailing Address
First Line	:	1340 FARNHAM PT APT 208
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-5202
Country	:	US
Telephone Number	:	318-715-8415
Fax Number	:

Provider Business Practice Location Address
First Line	:	US AIR FORCE/ FORT CARSON
Second Line	:	8420 SKYRAIDER RD
City	:	COLORADO SPRINGS
State	:	AA
Zip	:	80913
Country	:	US
Telephone Number	:	318-715-8415
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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