Provider Demographics
NPI:1093076986
Name:MILLER, JASON ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E ELLSWORTH AVE APT 1012
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2351
Mailing Address - Country:US
Mailing Address - Phone:702-204-3005
Mailing Address - Fax:
Practice Address - Street 1:1694 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3210
Practice Address - Country:US
Practice Address - Phone:970-593-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11698225100000X
UT8247259-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist