Healthcare Provider Details

I. General information

NPI: 1750050472
Provider Name (Legal Business Name): DEVON BRETZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 S PURCELL BLVD # 116
PUEBLO CO
81007-5083
US

IV. Provider business mailing address

4701 E MISSISSIPPI AVE
DENVER CO
80246-8206
US

V. Phone/Fax

Practice location:
  • Phone: 719-547-2481
  • Fax: 719-471-4415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0017880
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: