Healthcare Provider Details

I. General information

NPI: 1275442824
Provider Name (Legal Business Name): SALLY BROWN OT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 MAPLETON AVE
BOULDER CO
80301-1122
US

IV. Provider business mailing address

2187 MEAD DR
BOULDER CO
80301-5110
US

V. Phone/Fax

Practice location:
  • Phone: 720-363-7269
  • Fax:
Mailing address:
  • Phone: 720-363-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALLY BROWN
Title or Position: OWNER
Credential: MBA,OTR/L, CHT
Phone: 720-363-7269