Provider Demographics
NPI:1992028856
Name:NEWMAN, JEFFREY WILLARD (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLARD
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 STAR RANCH RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7660
Mailing Address - Country:US
Mailing Address - Phone:719-527-0669
Mailing Address - Fax:719-527-9893
Practice Address - Street 1:4715 STAR RANCH RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7660
Practice Address - Country:US
Practice Address - Phone:719-527-0669
Practice Address - Fax:719-527-9893
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018646225100000X, 2251S0007X, 2251X0800X
CO2406225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic