MEDICARE: SYMPATHETIC THERAPY CENTER PC

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	6755	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	$$$$$$$$$	OTHER	CO	SOCIAL SECURITY NUMBEWR

General Provider Information

NPI Number	:	1962568733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYMPATHETIC THERAPY CENTER PC

Provider Business Mailing Address
First Line	:	2413 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1107
Country	:	US
Telephone Number	:	719-271-1853
Fax Number	:	719-471-0760

Provider Business Practice Location Address
First Line	:	2413 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1107
Country	:	US
Telephone Number	:	719-271-1853
Fax Number	:	719-471-0760

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DAVID CHARLES CHARLAND
Credential	:	P.T.
Telephone Number	:	719-271-1853

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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