Provider Demographics
NPI:1518979798
Name:OBERT, BRIANNA RACHEL (MSPT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RACHEL
Last Name:OBERT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 DTC PKWY
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3023
Mailing Address - Country:US
Mailing Address - Phone:720-306-8261
Mailing Address - Fax:720-306-8231
Practice Address - Street 1:5300 DTC PKWY
Practice Address - Street 2:SUITE # 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3023
Practice Address - Country:US
Practice Address - Phone:720-306-8261
Practice Address - Fax:720-306-8231
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102072963OtherOWCP FACILITY ID
CO06-6600Medicare Oscar/Certification