Healthcare Provider Details

I. General information

NPI: 1538590971
Provider Name (Legal Business Name): BRENT SALLEE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS CO
80920-1024
US

IV. Provider business mailing address

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS CO
80920-1024
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-7340
  • Fax: 719-426-9857
Mailing address:
  • Phone: 719-434-7340
  • Fax: 719-426-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40824
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0017500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: