MEDICARE: JOLEEN NEW MPT

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	7612	CO

General Provider Information

NPI Number	:	1700292646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLEEN NEW MPT

Provider Business Mailing Address
First Line	:	8600 PARK MEADOWS DR STE 200
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2757
Country	:	US
Telephone Number	:	303-649-2165
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 PARK MEADOWS DR STE 200
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2757
Country	:	US
Telephone Number	:	303-649-2165
Fax Number	:

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	07/10/2014

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Directions to “ JOLEEN NEW MPT” Practice Location

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