Provider Demographics
NPI:1245688498
Name:MEDBERRY, STEVEN DAVID (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:MEDBERRY
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 1:1265 SGT JON STILES DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2266
Mailing Address - Country:US
Mailing Address - Phone:303-274-7332
Mailing Address - Fax:720-497-6733
Practice Address - Street 1:1265 SGT JON STILES DR UNIT D
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2266
Practice Address - Country:US
Practice Address - Phone:303-274-7332
Practice Address - Fax:720-497-6733
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist