MEDICARE: BROOKE ELIN BEMIS 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	0013169	CO
2	225100000X	Physical Therapist	PT-3019	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720339054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ELIN BEMIS DPT

Provider Business Mailing Address
First Line	:	1262 BERGEN PKWY UNIT E10
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9546
Country	:	US
Telephone Number	:	303-674-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1262 BERGEN PKWY UNIT E10
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439
Country	:	US
Telephone Number	:	303-674-7889
Fax Number	:

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

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	05/20/2026

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