Provider Demographics
NPI:1326141318
Name:LEWANDOWSKI, BRENT JOHN (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JOHN
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 E WOODMEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2605
Mailing Address - Country:US
Mailing Address - Phone:719-571-8888
Mailing Address - Fax:719-571-8889
Practice Address - Street 1:6011 E WOODMEN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2605
Practice Address - Country:US
Practice Address - Phone:719-571-8888
Practice Address - Fax:719-571-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52462Medicare ID - Type Unspecified