MEDICARE: BRENDA J FELLER MPT

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	3255	CO

General Provider Information

NPI Number	:	1659683514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA J FELLER MPT

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR STE 145
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-434-7340
Fax Number	:	719-426-9857

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR STE 145
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-434-7340
Fax Number	:	719-426-9857

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	08/06/2020

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