Provider Demographics
NPI:1104219054
Name:BRISSENDEN, ADAM RAMON (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RAMON
Last Name:BRISSENDEN
Suffix:
Gender:M
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 E PROSPECT RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1187
Mailing Address - Country:US
Mailing Address - Phone:970-568-8461
Mailing Address - Fax:970-460-0136
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3504
Practice Address - Country:US
Practice Address - Phone:401-782-4049
Practice Address - Fax:401-782-0890
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013158225100000X
RIPT02966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist