Provider Demographics
NPI:1114492378
Name:THEOHARRIS, MICHELE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:THEOHARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 W 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-2038
Mailing Address - Country:US
Mailing Address - Phone:303-641-1735
Mailing Address - Fax:
Practice Address - Street 1:5400 WARD RD BLDG 2
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1819
Practice Address - Country:US
Practice Address - Phone:303-641-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist