MEDICARE: JOHN JAMES LIGHTHART DPT

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	20987	CO

General Provider Information

NPI Number	:	1427911189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JAMES LIGHTHART DPT

Provider Business Mailing Address
First Line	:	1262 BERGEN PKWY UNIT E10
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9546
Country	:	US
Telephone Number	:	303-674-7889
Fax Number	:	303-674-8117

Provider Business Practice Location Address
First Line	:	1262 BERGEN PKWY UNIT E10
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9546
Country	:	US
Telephone Number	:	303-674-7889
Fax Number	:	303-674-8117

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/14/2025

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