MEDICARE: NORTHSTAR PHYSICAL THERAPY, PC

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	:	1720157258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	2180 HOLLOW BROOK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-599-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 HOLLOW BROOK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-599-5862
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN LEWIS
Credential	:
Telephone Number	:	719-599-5862

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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