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NPI Code Detail

MEDICARE: MIRANDA ELLINGTON PTA

MEDICARE: MIRANDA ELLINGTON PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist0014989CO

General Provider Information

NPI Number : 1528726049
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA ELLINGTON PTA
Provider Business Mailing Address
First Line : 8500 W CRESTLINE AVE UNIT G5
Second Line :
City : LITTLETON
State : CO
Zip : 80123-2222
Country : US
Telephone Number : 303-971-0500
Fax Number :
Provider Business Practice Location Address
First Line : 4450 E JEWELL AVE
Second Line :
City : DENVER
State : CO
Zip : 80222-4605
Country : US
Telephone Number : 303-757-7438
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2021
Last Update Date : 11/17/2024

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Directions to “ MIRANDA ELLINGTON PTA” Practice Location

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