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NPI Code Detail

MEDICARE: STEVE JACKSON BOLLENBACHER

MEDICARE: STEVE JACKSON BOLLENBACHER
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
1225100000XPhysical TherapistPTL.0015068CO

General Provider Information

NPI Number : 1831678952
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVE JACKSON BOLLENBACHER
Provider Business Mailing Address
First Line : PO BOX 2460
Second Line :
City : GYPSUM
State : CO
Zip : 81637-2460
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 851 E 5TH ST
Second Line :
City : RIFLE
State : CO
Zip : 81650-2941
Country : US
Telephone Number : 970-665-1041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2018
Last Update Date : 08/09/2018

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