Provider Demographics
NPI:1316306426
Name:LETT-BROWN, PAUL (PTA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LETT-BROWN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 DOWNEND ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4523
Mailing Address - Country:US
Mailing Address - Phone:719-388-6268
Mailing Address - Fax:719-375-1276
Practice Address - Street 1:5775 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1744
Practice Address - Country:US
Practice Address - Phone:719-434-7044
Practice Address - Fax:719-375-1276
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA0013414225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant