Provider Demographics
NPI:1720157258
Name:NORTHSTAR PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:NORTHSTAR PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-599-5862
Mailing Address - Street 1:2180 HOLLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1444
Mailing Address - Country:US
Mailing Address - Phone:719-599-5862
Mailing Address - Fax:
Practice Address - Street 1:2180 HOLLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1444
Practice Address - Country:US
Practice Address - Phone:719-599-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-6573Medicare ID - Type UnspecifiedPROVIDER