Individual
BRIAN G EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1830 BLAKE AVE, GLENWOOD SPRINGS, CO 81601-4275
(970) 945-8503
Mailing address
1830 BLAKE AVE, GLENWOOD SPRINGS, CO 81601-4275
(970) 945-8503
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7020
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7020
COLORADO LICENSE
CO
Enumeration date
09/22/2010
Last updated
09/22/2010
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