Healthcare Provider Details

I. General information

NPI: 1679012652
Provider Name (Legal Business Name): MICHAELA ROSCOE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 ACADEMY CIR
COLORADO SPRINGS CO
80909-1663
US

IV. Provider business mailing address

2105 ACADEMY CIR
COLORADO SPRINGS CO
80909-1663
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-5555
  • Fax:
Mailing address:
  • Phone: 719-598-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0013941
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: