Healthcare Provider Details

I. General information

NPI: 1083258206
Provider Name (Legal Business Name): MICHELLE A SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S WADSWORTH BLVD
LAKEWOOD CO
80227-3273
US

IV. Provider business mailing address

3550 W 38TH AVE APT 642
DENVER CO
80211-1895
US

V. Phone/Fax

Practice location:
  • Phone: 720-962-4555
  • Fax:
Mailing address:
  • Phone: 860-335-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00016000
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: