Provider Demographics
NPI:1184163230
Name:FELDT, BRIAN (PTA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FELDT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6630
Mailing Address - Country:US
Mailing Address - Phone:719-265-6601
Mailing Address - Fax:719-265-6649
Practice Address - Street 1:15909 JACKSON CREEK PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8693
Practice Address - Country:US
Practice Address - Phone:719-481-0897
Practice Address - Fax:719-481-0022
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013169225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant