Healthcare Provider Details

I. General information

NPI: 1174303366
Provider Name (Legal Business Name): MICHELLE DENISE RUZICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 RALEIGH ST
WESTMINSTER CO
80030-5914
US

IV. Provider business mailing address

7522 NIKAU CT
NIWOT CO
80503-7268
US

V. Phone/Fax

Practice location:
  • Phone: 303-487-2748
  • Fax:
Mailing address:
  • Phone: 720-317-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0006554
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: