MEDICARE: ERIN BRUNELLE

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	13052	AZ

General Provider Information

NPI Number	:	1609305465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN BRUNELLE

Provider Business Mailing Address
First Line	:	1417 E COLTER ST APT 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 W 120TH AVE STE 310
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3493
Country	:	US
Telephone Number	:	888-265-2680
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	06/06/2017

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Directions to “ ERIN BRUNELLE ” Practice Location

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