Provider Demographics
NPI:1598284002
Name:DACUS, BRYANA (DPT)
Entity Type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:DACUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRYANA
Other - Middle Name:
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7310 S ALTON WAY STE 6L
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2351
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:
Practice Address - Street 1:2015 CLUBHOUSE DR STE 102
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3651
Practice Address - Country:US
Practice Address - Phone:970-506-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist