Provider Demographics
NPI:1124543590
Name:TAYLOR, MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16365 E 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-7114
Mailing Address - Country:US
Mailing Address - Phone:303-472-7354
Mailing Address - Fax:
Practice Address - Street 1:12909 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:CO
Practice Address - Zip Code:80640-9146
Practice Address - Country:US
Practice Address - Phone:303-655-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer