Individual
BRANDON G BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
441 UNIVERSITY ST, TRINIDAD, CO 81082-2542
(719) 846-1500
(719) 846-1501
Mailing address
441 UNIVERSITY ST, TRINIDAD, CO 81082-2542
(719) 846-1500
(719) 846-1501
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5147BACA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26372231
—
CO
Enumeration date
10/11/2006
Last updated
07/30/2010
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