MEDICARE: JASON LYNN WILKINSON DPT

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	PTL.0016583	CO

General Provider Information

NPI Number	:	1871837138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON LYNN WILKINSON DPT

Provider Business Mailing Address
First Line	:	2965 DEL REY PLZ
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1800
Country	:	US
Telephone Number	:	719-229-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 SCARBOROUGH DR STE 350
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7582
Country	:	US
Telephone Number	:	719-590-7777
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	10/24/2019

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