Provider Demographics
NPI:1497835326
Name:BUSEY, BRIAN L (MPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:BUSEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 LOWE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5741
Mailing Address - Country:US
Mailing Address - Phone:970-223-6339
Mailing Address - Fax:970-223-6382
Practice Address - Street 1:2032 LOWE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5741
Practice Address - Country:US
Practice Address - Phone:970-223-6339
Practice Address - Fax:970-223-6382
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-11212251X0800X
CO84522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYP00228467OtherRAIL ROAD MEDICARE
WY313528OtherBLUE CROSS BLUE SHIELD
WY20285Medicare ID - Type Unspecified
COC308693Medicare PIN