Provider Demographics
NPI:1386719912
Name:BRUNNER, REBECCA J (MPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:150 OLD LARAMIE TRL E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7018
Mailing Address - Country:US
Mailing Address - Phone:303-665-8747
Mailing Address - Fax:303-926-0184
Practice Address - Street 1:150 OLD LARAMIE TRL E
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7018
Practice Address - Country:US
Practice Address - Phone:303-665-8747
Practice Address - Fax:303-926-0184
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4501822Medicare PIN