MEDICARE: NEURO LOGIC REHABILITATION AND WELLNESS

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	:	1700470168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO LOGIC REHABILITATION AND WELLNESS

Provider Business Mailing Address
First Line	:	114 SUNBIRD CLIFFS LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8013
Country	:	US
Telephone Number	:	847-502-5971
Fax Number	:	719-691-7994

Provider Business Practice Location Address
First Line	:	114 SUNBIRD CLIFFS LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8013
Country	:	US
Telephone Number	:	847-502-5971
Fax Number	:	719-691-7994

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN MUELLER
Credential	:
Telephone Number	:	847-502-5971

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	04/02/2024

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