Provider Demographics
NPI:1346542529
Name:SMITH, BRIAN GERARD
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GERARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:GERARD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7150 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4861
Mailing Address - Country:US
Mailing Address - Phone:570-233-2535
Mailing Address - Fax:
Practice Address - Street 1:2323 S TROY ST
Practice Address - Street 2:BLDG3 SUITE 107
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1946
Practice Address - Country:US
Practice Address - Phone:303-209-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist