Provider Demographics
NPI:1346528148
Name:MENGES, MICAH J (DPT)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:J
Last Name:MENGES
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 1:602 ELKTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3514
Mailing Address - Country:US
Mailing Address - Phone:719-559-0680
Mailing Address - Fax:719-559-0681
Practice Address - Street 1:602 ELKTON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-559-0680
Practice Address - Fax:719-559-0681
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9395225100000X
COPTL.0011847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist