Provider Demographics
NPI:1336299023
Name:MIGLIZZI, CORY L (CMT LMT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:L
Last Name:MIGLIZZI
Suffix:
Gender:M
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 S ESPANA ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5818
Mailing Address - Country:US
Mailing Address - Phone:303-259-9949
Mailing Address - Fax:
Practice Address - Street 1:4603 S ESPANA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5818
Practice Address - Country:US
Practice Address - Phone:303-259-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53181225700000X
CO91748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist