Healthcare Provider Details

I. General information

NPI: 1316565658
Provider Name (Legal Business Name): BREANNA M BUNTIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA M NEDDEN PT

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax: 303-694-9666
Mailing address:
  • Phone: 970-624-1103
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-REG-0001140
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0019753
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: