Basic Information
| Provider Information | |||||||||
| NPI: | 1710393897 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GALVIN | ||||||||
| FirstName: | BREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2490 W 26TH AVE | ||||||||
| Address2: | A-200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802115314 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8725 WADSWORTH BLVD | ||||||||
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| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800030928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034257298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 09/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT.0014785 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225100000X | 0012828 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.