Provider Demographics
NPI:1710478045
Name:STEPHENS, BROOK TYLER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:TYLER
Last Name:STEPHENS
Suffix:
Gender:M
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 1:23 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7213
Mailing Address - Country:US
Mailing Address - Phone:719-722-7806
Mailing Address - Fax:
Practice Address - Street 1:23 SPRUCE CT
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7213
Practice Address - Country:US
Practice Address - Phone:719-722-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015630225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist