MEDICARE: DR. BRIANNA WAHL

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	PTL-11314	CO

General Provider Information

NPI Number	:	1588952279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIANNA WAHL

Provider Business Mailing Address
First Line	:	1201 E 17TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1574
Country	:	US
Telephone Number	:	303-832-3700
Fax Number	:	303-429-6255

Provider Business Practice Location Address
First Line	:	1201 E 17TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1574
Country	:	US
Telephone Number	:	303-832-3700
Fax Number	:	303-429-6255

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	03/14/2016

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