Provider Demographics
NPI:1922489814
Name:KRELL, BRAD (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:KRELL
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5954 S QUATAR CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5015
Mailing Address - Country:US
Mailing Address - Phone:303-250-4291
Mailing Address - Fax:720-306-2352
Practice Address - Street 1:5954 S QUATAR CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5015
Practice Address - Country:US
Practice Address - Phone:303-250-4291
Practice Address - Fax:720-306-2352
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00132602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO465684995Medicaid