Healthcare Provider Details

I. General information

NPI: 1487177549
Provider Name (Legal Business Name): ALEXANDER ROBERT MIERAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 RIDGELINE BLVD STE 102
HIGHLANDS RANCH CO
80129-2354
US

IV. Provider business mailing address

415 ANGUS WAY
HIGHLANDS RANCH CO
80129-6227
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-9974
  • Fax:
Mailing address:
  • Phone: 720-841-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10411567-8016
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0015719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: