Healthcare Provider Details

I. General information

NPI: 1861776288
Provider Name (Legal Business Name): BRITA DESTEFANO PT, DPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 S GAYLORD ST
DENVER CO
80210
US

IV. Provider business mailing address

3015 S GAYLORD ST
DENVER CO
80210-6023
US

V. Phone/Fax

Practice location:
  • Phone: 512-573-4651
  • Fax:
Mailing address:
  • Phone: 512-573-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3369
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0012137
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: