Provider Demographics
NPI:1669028114
Name:NICHOLAS, MILES (DPT)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:NICHOLAS
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 1:3801 E FLORIDA AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2546
Mailing Address - Country:US
Mailing Address - Phone:303-370-2670
Mailing Address - Fax:303-370-2696
Practice Address - Street 1:3801 E FLORIDA AVE STE 330
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2546
Practice Address - Country:US
Practice Address - Phone:303-370-2670
Practice Address - Fax:303-370-2696
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029363225100000X
MA24469225100000X
COPTL.0018069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24469OtherMA ALLIED HEALTH