Provider Demographics
NPI:1689295909
Name:VAN DE CASTEELE, BRIANNA LYNNE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNNE
Last Name:VAN DE CASTEELE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:LYNNE
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:5698 KINGSBORO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8250 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4301
Practice Address - Country:US
Practice Address - Phone:719-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00017952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer