Provider Demographics
NPI:1871535468
Name:SHIPLEY, BRANDI L (PT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:L
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2835 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1662
Mailing Address - Country:US
Mailing Address - Phone:719-533-1318
Mailing Address - Fax:719-533-1319
Practice Address - Street 1:2835 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1662
Practice Address - Country:US
Practice Address - Phone:719-533-1318
Practice Address - Fax:719-533-1319
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC545438Medicare PIN