Healthcare Provider Details

I. General information

NPI: 1346528148
Provider Name (Legal Business Name): MICAH J MENGES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ELKTON DR
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

602 ELKTON DR
COLORADO SPRINGS CO
80907-3514
US

V. Phone/Fax

Practice location:
  • Phone: 719-559-0680
  • Fax: 719-559-0681
Mailing address:
  • Phone: 719-559-0680
  • Fax: 719-559-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9395
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0011847
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: