Healthcare Provider Details

I. General information

NPI: 1417407495
Provider Name (Legal Business Name): CARLI MENZEL BRAKEFIELD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 E ILIFF AVE STE 304
DENVER CO
80231-3462
US

IV. Provider business mailing address

9900 E ILIFF AVE
DENVER CO
80231-3462
US

V. Phone/Fax

Practice location:
  • Phone: 303-636-5600
  • Fax:
Mailing address:
  • Phone: 303-636-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTL0015767
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: