MEDICARE: LESLIE ROBERGE JAMISON 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	J10003607	DE
2	225100000X	Physical Therapist	26271	MD
3	225100000X	Physical Therapist	PTL.0016296	CO

General Provider Information

NPI Number	:	1568914349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ROBERGE JAMISON DPT

Provider Business Mailing Address
First Line	:	6336 BUCHANAN ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5810
Country	:	US
Telephone Number	:	970-682-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	6336 BUCHANAN ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5810
Country	:	US
Telephone Number	:	970-682-4460
Fax Number	:

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

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	06/03/2024

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