Provider Demographics
NPI:1306414883
Name:CARTER, BRETT RYAN (LMT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:RYAN
Last Name:CARTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 8TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3312
Mailing Address - Country:US
Mailing Address - Phone:970-852-0454
Mailing Address - Fax:
Practice Address - Street 1:214 8TH ST STE 204
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3312
Practice Address - Country:US
Practice Address - Phone:970-852-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0018737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist