Provider Demographics
NPI:1598723694
Name:LANDOW, MICHELLE (PT,MS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:LANDOW
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22813 E PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6554
Mailing Address - Country:US
Mailing Address - Phone:303-766-0298
Mailing Address - Fax:
Practice Address - Street 1:7340 S ALTON WAY
Practice Address - Street 2:STE 11-D
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2335
Practice Address - Country:US
Practice Address - Phone:720-493-1181
Practice Address - Fax:720-493-1191
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23139331Medicaid
CO23139331Medicaid