MEDICARE: COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1720973597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 392977
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9977
Country	:	US
Telephone Number	:	412-567-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 E FILLMORE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6402
Country	:	US
Telephone Number	:	719-895-1722
Fax Number	:	719-895-1723

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MELANIE REDFERN CATALDO
Credential	:
Telephone Number	:	412-567-2400

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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