Healthcare Provider Details

I. General information

NPI: 1396105235
Provider Name (Legal Business Name): TARA MICHELLE ARVIDSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 E ARAPAHOE RD STE 1000
CENTENNIAL CO
80112-5084
US

IV. Provider business mailing address

11211 E ARAPAHOE RD STE 1000
CENTENNIAL CO
80112-5084
US

V. Phone/Fax

Practice location:
  • Phone: 720-791-2881
  • Fax:
Mailing address:
  • Phone: 720-791-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0016076
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: