Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTL.0017179 | CO |
NPI | 1326651498 |
---|---|
Provider Name | Christopher M Juneau |
First Address | Colorado Springs, CO 80904-5202 |
Second Address | Colorado Springs, AA 80913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |