MEDICARE: KAREN WENNING STELLICK PT

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	3363	CO

General Provider Information

NPI Number	:	1770512352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN WENNING STELLICK PT

Provider Business Mailing Address
First Line	:	1775 S 8TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1926
Country	:	US
Telephone Number	:	719-477-6870
Fax Number	:	719-477-1483

Provider Business Practice Location Address
First Line	:	1775 S 8TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1926
Country	:	US
Telephone Number	:	719-477-6870
Fax Number	:	719-477-1483

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/11/2012

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