Provider Demographics
NPI:1104112911
Name:STANDORF, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:STANDORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W BELLEVIEW AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7186
Mailing Address - Country:US
Mailing Address - Phone:303-738-5903
Mailing Address - Fax:
Practice Address - Street 1:2610 W BELLEVIEW AVE
Practice Address - Street 2:STE. 300
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7186
Practice Address - Country:US
Practice Address - Phone:303-738-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist