MEDICARE: JUDY MARGARET CULBERTSON P.T.

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	2615	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102255332	OTHER		OWCP FACILITY ID

General Provider Information

NPI Number	:	1790794279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MARGARET CULBERTSON P.T.

Provider Business Mailing Address
First Line	:	6979 S HOLLY CIR
Second Line	:	STE 105
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-1577
Country	:	US
Telephone Number	:	303-694-2295
Fax Number	:	303-694-1843

Provider Business Practice Location Address
First Line	:	9330 S UNIVERSITY BLVD
Second Line	:	STE 140
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-5065
Country	:	US
Telephone Number	:	303-471-4506
Fax Number	:	303-471-4364

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/09/2007

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