Provider Demographics
NPI:1942719067
Name:MILBERT, MACY FRANCIS
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:FRANCIS
Last Name:MILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4199
Mailing Address - Country:US
Mailing Address - Phone:936-240-2216
Mailing Address - Fax:
Practice Address - Street 1:2377 ROBINS WAY
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5901
Practice Address - Country:US
Practice Address - Phone:970-252-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant