MEDICARE: BREANNA M BUNTIN 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	PTP-PT-REG-0001140	MT
2	225100000X	Physical Therapist	PTL.0019753	CO

General Provider Information

NPI Number	:	1316565658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA M BUNTIN DPT

Provider Business Mailing Address
First Line	:	4650 W MINERAL DR UNIT 1113
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-2587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 W MINERAL DR UNIT 1113
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-2587
Country	:	US
Telephone Number	:	715-610-5920
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	06/04/2026

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Directions to “ BREANNA M BUNTIN DPT” Practice Location

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