Basic Information
| Provider Information | |||||||||
| NPI: | 1215057351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 S TAFT CT | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800279510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203395552 | ||||||||
| FaxNumber: | 3034021665 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 W SOUTH BOULDER RD | ||||||||
| Address2: | #100 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800271156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036016666 | ||||||||
| FaxNumber: | 3034473390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 03/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 9624 | 01 | CO | CO LICENSE | OTHER |