MEDICARE: DR. KEVIN WALLEWEIN 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	6561	CO

General Provider Information

NPI Number	:	1972717742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN WALLEWEIN DPT

Provider Business Mailing Address
First Line	:	1775 PIROS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-4308
Country	:	US
Telephone Number	:	719-235-8488
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 S PARKSIDE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3134
Country	:	US
Telephone Number	:	719-630-8000
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/10/2012

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