Healthcare Provider Details

I. General information

NPI: 1669880837
Provider Name (Legal Business Name): PAWEL BRONKOWSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 STADIUM DR
BOULDER CO
80309
US

IV. Provider business mailing address

5450 WESTERN AVE
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-315-9900
  • Fax: 303-315-9901
Mailing address:
  • Phone: 303-315-9900
  • Fax: 303-315-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTL.0015927
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: