Healthcare Provider Details

I. General information

NPI: 1669028114
Provider Name (Legal Business Name): MILES NICHOLAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E FLORIDA AVE STE 330
DENVER CO
80210-2546
US

IV. Provider business mailing address

3801 E FLORIDA AVE STE 330
DENVER CO
80210-2546
US

V. Phone/Fax

Practice location:
  • Phone: 303-370-2670
  • Fax: 303-370-2696
Mailing address:
  • Phone: 303-370-2670
  • Fax: 303-370-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT029363
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24469
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018069
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: