MEDICARE: MS. MARCIA BETH BIRKENKAMP RPT

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	3304	CO

General Provider Information

NPI Number	:	1801961271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA BETH BIRKENKAMP RPT

Provider Business Mailing Address
First Line	:	511 CROSSING DR STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2629
Country	:	US
Telephone Number	:	303-665-8747
Fax Number	:	303-926-0184

Provider Business Practice Location Address
First Line	:	511 CROSSING DR STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2629
Country	:	US
Telephone Number	:	303-665-8747
Fax Number	:	303-926-0184

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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