Healthcare Provider Details

I. General information

NPI: 1073322954
Provider Name (Legal Business Name): MAIZIE NEL DEIHL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9108 W 6TH AVE
LAKEWOOD CO
80215-5121
US

IV. Provider business mailing address

742 SILVER MAPLE DR
NEW PRAGUE MN
56071-4194
US

V. Phone/Fax

Practice location:
  • Phone: 303-484-1232
  • Fax:
Mailing address:
  • Phone: 952-217-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020319
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: