MEDICARE: BRADLY J GOLDEN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0010602	CO

General Provider Information

NPI Number	:	1275853723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLY J GOLDEN DPT

Provider Business Mailing Address
First Line	:	1503 LUCE CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-9679
Country	:	US
Telephone Number	:	970-631-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 LUCE CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-9679
Country	:	US
Telephone Number	:	970-631-8304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	04/11/2016

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