Provider Demographics
NPI:1255417648
Name:MILLER, MICHELLE S (MSPT, COMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSPT, COMT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:KIEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1216 ARAPAHOE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1124
Mailing Address - Country:US
Mailing Address - Phone:303-279-9728
Mailing Address - Fax:303-278-0180
Practice Address - Street 1:1216 ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1124
Practice Address - Country:US
Practice Address - Phone:303-279-9728
Practice Address - Fax:303-278-0180
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3197OtherMEDICARE PTAN
AKK151390Medicare ID - Type Unspecified