Provider Demographics
NPI:1598754434
Name:EIGSTI, BRADLEY K (PT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:K
Last Name:EIGSTI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8231
Mailing Address - Fax:866-210-0907
Practice Address - Street 1:7780 S BROADWAY STE 170
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:303-730-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066615OtherMEDICARE GROUP #