Provider Demographics
NPI:1992148670
Name:STREETER, BRET AARON I (PTA)
Entity type:Individual
Prefix:MR
First Name:BRET
Middle Name:AARON
Last Name:STREETER
Suffix:I
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 1:4775 ARGONNE ST
Mailing Address - Street 2:Q-204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7400
Mailing Address - Country:US
Mailing Address - Phone:360-607-9676
Mailing Address - Fax:
Practice Address - Street 1:4775 ARGONNE ST
Practice Address - Street 2:Q-204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7400
Practice Address - Country:US
Practice Address - Phone:360-607-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant