Provider Demographics
NPI:1295079671
Name:BRUNER, BETH STEDMAN (MPT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:STEDMAN
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OAK LEAF CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9499
Mailing Address - Country:US
Mailing Address - Phone:970-568-8730
Mailing Address - Fax:
Practice Address - Street 1:1939 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6404
Practice Address - Country:US
Practice Address - Phone:970-377-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0011940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist