Healthcare Provider Details

I. General information

NPI: 1851797211
Provider Name (Legal Business Name): PEDIATRIC SPEECH THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S COLORADO BLVD STE 150
DENVER CO
80246-1904
US

IV. Provider business mailing address

6851 S HOLLY CIR STE 295
CENTENNIAL CO
80112-1019
US

V. Phone/Fax

Practice location:
  • Phone: 720-542-8737
  • Fax: 720-242-8085
Mailing address:
  • Phone: 720-542-8737
  • Fax: 720-242-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1848
License Number StateCO

VIII. Authorized Official

Name: BRYAN SHEPHERD
Title or Position: PRESIDENT
Credential: OTHER
Phone: 720-542-8737