Individual provider Active NPI

Leslie Roberge Jamison, DPT

  • Physical Therapist
  • Fort Collins, CO
National Provider Identifier
1568914349
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL.0016296 Issued in CO
Practice address
6336 Buchanan St
Fort Collins, CO 80525-5810
Phone
(970) 682-4460
NPI assigned
Oct 27, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X J10003607 DE
Physical Therapist 225100000X 26271 MD
Physical Therapist 225100000X PTL.0016296 CO Primary

Addresses

Primary practice location

6336 Buchanan St
Fort Collins, CO 80525-5810

Mailing address

6336 Buchanan St
Fort Collins, CO 80525-5810
Phone (970) 682-4460

Other practice location 1

375 E Horsetooth Rd Ste 104
Fort Collins, CO 80525-3155
Phone (970) 286-2868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190522002504 CO Practitioner - Physical Therapist in Private Practice 8325322910 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
J10003607DEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Select Physical Therapy Holdings Inc CurrentSince Mar 1, 2022 Accepting new patients
Select Physical Therapy Holdings Inc CurrentSince Mar 1, 2022 Accepting new patients
Select Physical Therapy Holdings Inc Physical Therapist Current Accepting new patients
Colorado Mobile PT LLC Physical Therapist CurrentSince Dec 21, 2020 Accepting new patients
Select Physical Therapy Holdings Inc Physical Therapist Past Accepting new patients

Locations

6980 Mesa Ridge Pkwy
Ste 100
Fountain, CO 80817
Phone (719) 391-0044

730 14th St SW
Ste 200
Loveland, CO 80537
Phone (970) 286-2868

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1568914349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6336 BUCHANAN ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255810",
            "telephone_number": "970-682-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6336 BUCHANAN ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255810",
            "telephone_number": "970-682-4460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "375 E Horsetooth Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805253155",
            "country_code": "US",
            "telephone_number": "970-286-2868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAMISON",
        "first_name": "LESLIE",
        "middle_name": "ROBERGE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-27",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J10003607",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "26271",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0016296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.