Healthcare Provider Details

I. General information

NPI: 1093559791
Provider Name (Legal Business Name): SPENCER COLE BRISTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WADSWORTH BLVD STE 200
WHEAT RIDGE CO
80033-4634
US

IV. Provider business mailing address

2710 SPEEDWAY AVE
WICHITA FALLS TX
76308-1109
US

V. Phone/Fax

Practice location:
  • Phone: 303-940-7222
  • Fax:
Mailing address:
  • Phone: 940-704-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3133554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: