Provider Demographics
NPI:1710393897
Name:GALVIN, BREA
Entity Type:Individual
Prefix:
First Name:BREA
Middle Name:
Last Name:GALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:A-200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8725 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0928
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014785225700000X
CO0012828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist