Organization
BAL SWAN CHILDREN'S CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN SCOTT CONLY (EXECUTIVE DIRECTOR)
(303) 466-6308
Entity
Organization
Contact information
Practice address
1145 E 13TH AVE, BROOMFIELD, CO 80020-1301
(303) 466-6308
(303) 466-1224
Mailing address
1145 E 13TH AVE, BROOMFIELD, CO 80020-1301
(303) 466-6308
(303) 466-1224
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08103747
—
CO
Enumeration date
05/22/2007
Last updated
06/24/2008
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