Provider Demographics
NPI:1003000829
Name:KOCHANEK, MICHELLE RENEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:KOCHANEK
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:GARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8501 E ALAMEDA AVE UNIT 1334
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6041
Mailing Address - Country:US
Mailing Address - Phone:312-718-3292
Mailing Address - Fax:
Practice Address - Street 1:8501 E ALAMEDA AVE UNIT 1334
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6041
Practice Address - Country:US
Practice Address - Phone:312-718-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015931225100000X
COPTL.0012104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01622333OtherBLUE CROSS BLUE SHIELD ID
7454077OtherAETNA