Provider Demographics
NPI:1437148343
Name:HARRIS, MICHELLE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 BERRY PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6899
Mailing Address - Country:US
Mailing Address - Phone:303-578-2018
Mailing Address - Fax:303-578-7231
Practice Address - Street 1:5603 ARAPAHOE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1377
Practice Address - Country:US
Practice Address - Phone:303-578-2018
Practice Address - Fax:303-578-7231
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0003553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3553OtherPT LICENSE #