Provider Demographics
NPI:1023250925
Name:ALBERTO, MICHAEL ALEXANDER (LMT, NMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:ALBERTO
Suffix:
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5324
Mailing Address - Country:US
Mailing Address - Phone:719-650-1842
Mailing Address - Fax:
Practice Address - Street 1:2760 N ACADEMY BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5324
Practice Address - Country:US
Practice Address - Phone:719-650-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-4553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist