Provider Demographics
NPI:1952851834
Name:BROUWER, JESSICA (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BROUWER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 E QUINCY AVE
Mailing Address - Street 2:APT D105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16522 KEYSTONE BLVD
Practice Address - Street 2:UNIT N
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3303
Practice Address - Country:US
Practice Address - Phone:303-840-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist