Provider Demographics
NPI:1568241347
Name:BROWN, WELLSLEY MONTGOMERY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WELLSLEY
Middle Name:MONTGOMERY
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 BARRANCA LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7419
Mailing Address - Country:US
Mailing Address - Phone:720-733-5280
Mailing Address - Fax:720-733-5281
Practice Address - Street 1:4404 BARRANCA LN STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7419
Practice Address - Country:US
Practice Address - Phone:720-733-5280
Practice Address - Fax:720-733-5281
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist