Provider Demographics
NPI:1891434874
Name:VANDER MOLEN, BREANN KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:KATHLEEN
Last Name:VANDER MOLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:KATHLEEN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 OAKWOOD PARK PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1885
Mailing Address - Country:US
Mailing Address - Phone:720-788-7365
Mailing Address - Fax:720-294-0284
Practice Address - Street 1:19284 COTTONWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3881
Practice Address - Country:US
Practice Address - Phone:720-788-7365
Practice Address - Fax:720-294-1426
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist