Provider Demographics
NPI:1396382172
Name:BRYANT-GODSEY, JONATHON BRANDON
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:BRANDON
Last Name:BRYANT-GODSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9838 BUCKNELL WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-4396
Mailing Address - Country:US
Mailing Address - Phone:719-214-6760
Mailing Address - Fax:
Practice Address - Street 1:3350 PEORIA ST STE 190
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1484
Practice Address - Country:US
Practice Address - Phone:303-365-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant