MEDICARE: AMY BRAND MPT

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	2251X0800X	Orthopedic Physical Therapist	8759	CO

General Provider Information

NPI Number	:	1760448112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BRAND MPT

Provider Business Mailing Address
First Line	:	30940 STAGECOACH BLVD
Second Line	:	SUITE E110
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7984
Country	:	US
Telephone Number	:	303-674-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	30940 STAGECOACH BLVD
Second Line	:	SUITE E110
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7984
Country	:	US
Telephone Number	:	303-674-1594
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/09/2007

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