MEDICARE: MICHAEL GRIFFITH PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	0013004	CO

General Provider Information

NPI Number	:	1417370891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GRIFFITH PTA

Provider Business Mailing Address
First Line	:	720 16TH ST APT 504
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-3238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 16TH ST APT 504
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-3238
Country	:	US
Telephone Number	:	303-378-1604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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