Healthcare Provider Details

I. General information

NPI: 1811610348
Provider Name (Legal Business Name): DR. BRIAN J. MILLETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 QUAIL LAKE LOOP STE 100
COLORADO SPRINGS CO
80906-4651
US

IV. Provider business mailing address

4701 MONTEREY OAKS BLVD APT 425
AUSTIN TX
78749-1087
US

V. Phone/Fax

Practice location:
  • Phone: 719-579-0230
  • Fax:
Mailing address:
  • Phone: 708-296-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1367965
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP052596T
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP034875T
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL88769
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: