MEDICARE: CHRISTOPHER FAHS 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	11116	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11116	OTHER	CO	CO LICENSE NUMBER

General Provider Information

NPI Number	:	1366507311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER FAHS PT

Provider Business Mailing Address
First Line	:	315 W SOUTH BOULDER RD
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1156
Country	:	US
Telephone Number	:	303-666-4151
Fax Number	:	303-666-4166

Provider Business Practice Location Address
First Line	:	315 W SOUTH BOULDER RD
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1156
Country	:	US
Telephone Number	:	303-666-4151
Fax Number	:	303-666-4166

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/31/2012

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Directions to “ CHRISTOPHER FAHS PT” Practice Location

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