Provider Demographics
NPI:1073617726
Name:MILLIFF, JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:MILLIFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 GARLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2201
Mailing Address - Country:US
Mailing Address - Phone:303-449-9061
Mailing Address - Fax:
Practice Address - Street 1:2955 BASELINE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2356
Practice Address - Country:US
Practice Address - Phone:303-444-8707
Practice Address - Fax:303-444-8109
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3155OtherPT LICENSE
CO25423Medicare ID - Type Unspecified