1255853826 NPI number — ANGELA KATHRYN BRICKMAN RBT-17-36119

Table of content: AARON MICHAEL CARTER MD (NPI 1528247806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255853826 NPI number — ANGELA KATHRYN BRICKMAN RBT-17-36119

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRICKMAN
Provider First Name:
ANGELA
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT-17-36119
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255853826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 RIDGESIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-5758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-503-6623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 RIDGESIDE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-503-6623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-17-36119 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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