Provider Demographics
NPI:1760448112
Name:BRAND, AMY (MPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30940 STAGECOACH BLVD
Mailing Address - Street 2:SUITE E110
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7984
Mailing Address - Country:US
Mailing Address - Phone:303-674-1594
Mailing Address - Fax:
Practice Address - Street 1:30940 STAGECOACH BLVD
Practice Address - Street 2:SUITE E110
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7984
Practice Address - Country:US
Practice Address - Phone:303-674-1594
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804411Medicare PIN