Provider Demographics
NPI:1679112957
Name:HARVEY, BROOKE LEIGH (LAT ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7640
Mailing Address - Country:US
Mailing Address - Phone:970-405-8038
Mailing Address - Fax:
Practice Address - Street 1:6900 E 47TH AVENUE DR STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3401
Practice Address - Country:US
Practice Address - Phone:303-920-1200
Practice Address - Fax:303-920-1281
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0405020052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty