MEDICARE: PINNACLE PHYSICAL THERAPY, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1538655964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	2545 BRENTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 BRENTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1583
Country	:	US
Telephone Number	:	815-608-4486
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHILLIP HEUER
Credential	:	PT
Telephone Number	:	815-608-4486

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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