MEDICARE: MR. BRANDON KYLE SHEEHAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305213336	VA
2	225100000X	Physical Therapist	MSPTL.000031	CO

General Provider Information

NPI Number	:	1295169506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANDON KYLE SHEEHAN DPT

Provider Business Mailing Address
First Line	:	6980 MESA RIDGE PKWY
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1563
Country	:	US
Telephone Number	:	719-391-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	6980 MESA RIDGE PKWY
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1563
Country	:	US
Telephone Number	:	719-391-0044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	05/20/2025

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