Provider Demographics
NPI:1770060592
Name:WHITWORTH, BRAD (LMT)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 S QUEBEC ST APT C208
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2667
Mailing Address - Country:US
Mailing Address - Phone:303-619-3016
Mailing Address - Fax:
Practice Address - Street 1:2570 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5909
Practice Address - Country:US
Practice Address - Phone:720-609-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0021547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist