Provider Demographics
NPI:1659683514
Name:FELLER, BRENDA J (MPT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:FELLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:STIRM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:595 CHAPEL HILLS DR STE 145
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1024
Mailing Address - Country:US
Mailing Address - Phone:719-434-7340
Mailing Address - Fax:719-426-9857
Practice Address - Street 1:595 CHAPEL HILLS DR STE 145
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1024
Practice Address - Country:US
Practice Address - Phone:719-434-7340
Practice Address - Fax:719-426-9857
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist