MEDICARE: ACTION POTENTIAL RLLP

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

General Provider Information

NPI Number	:	1528005220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION POTENTIAL RLLP

Provider Business Mailing Address
First Line	:	2035 CORTE DEL NOGAL STE 200
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 MAIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1713
Country	:	US
Telephone Number	:	719-392-7777
Fax Number	:	719-235-5982

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT PACE
Credential	:
Telephone Number	:	213-804-1712

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/18/2020

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Directions to “ACTION POTENTIAL RLLP ” Practice Location

Language	Start Address	Practice Location

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