Healthcare Provider Details

I. General information

NPI: 1043155005
Provider Name (Legal Business Name): BRIAN ANDREATTA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 US HIGHWAY 160
WALSENBURG CO
81089-9524
US

IV. Provider business mailing address

23500 U.S. HIGHWAY 160
PUEBLO CO
81004-3247
US

V. Phone/Fax

Practice location:
  • Phone: 719-989-0019
  • Fax:
Mailing address:
  • Phone: 719-989-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018867
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: