Provider Demographics
NPI:1942802913
Name:SANDERSON, BRIAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SANDERSON
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 1:4515 W MINERAL DR UNIT 334
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-2562
Mailing Address - Country:US
Mailing Address - Phone:402-301-4566
Mailing Address - Fax:
Practice Address - Street 1:1500 LITTLE RAVEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6248
Practice Address - Country:US
Practice Address - Phone:720-360-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist