Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PTA.0013187 | CO |
NPI | 1033673553 |
---|---|
Provider Name | Sara Jean Brandow |
First Address | Colorado Springs, CO 80923-8710 |
Second Address | Colorado Springs, CO 80920-3480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 29/01/2019 |