Provider Demographics
NPI:1962871947
Name:BROWN, COLLEEN MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:VIERK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5988 STETSON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3567
Mailing Address - Country:US
Mailing Address - Phone:810-667-4374
Mailing Address - Fax:
Practice Address - Street 1:609 PRONGHORN TRL STE C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7090
Practice Address - Country:US
Practice Address - Phone:406-580-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013870225100000X
MI5501017432225100000X
MT21680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist