Provider Demographics
NPI:1730739087
Name:PARK THERAPY
Entity type:Organization
Organization Name:PARK THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:GRESHAM
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-560-6488
Mailing Address - Street 1:4392 BALSAM ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4467
Mailing Address - Country:US
Mailing Address - Phone:512-560-6488
Mailing Address - Fax:
Practice Address - Street 1:4392 BALSAM ST UNIT A
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4467
Practice Address - Country:US
Practice Address - Phone:512-560-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy