Provider Demographics
NPI:1073163671
Name:BOSTOCK, BRET (CO)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:BOSTOCK
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 S ULSTER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3011
Mailing Address - Country:US
Mailing Address - Phone:602-919-1037
Mailing Address - Fax:
Practice Address - Street 1:4582 S ULSTER ST STE 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3011
Practice Address - Country:US
Practice Address - Phone:720-475-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist