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General NPI Number Information
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NPI Number | 1538906086
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Entity Type | Individual
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Provider Name | MILES JEFFREY CAGLE
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Gender | Male
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 4500 E CHERRY CREEK SOUTH DR STE 710
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City | DENVER
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State | CO
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Zip | 80246-1534
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Country | US
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Telephone | 303-432-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 839 GARDEN PARK RD
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City | CANON CITY
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State | CO
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Zip | 81212-9618
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Country | US
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Telephone | 719-458-0799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0014475
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License Number State | CO
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