1760995047 NPI number — MICHELE WESLEY PHYSICAL THERAPY LLC

Table of content: JENNIFER CHRISTINE FERRIS M.A., LPC (NPI 1639306772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760995047 NPI number — MICHELE WESLEY PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELE WESLEY PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760995047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3540 ZANE GRAY LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80138-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-550-6786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3540 ZANE GRAY LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-550-6786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WESLEY
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
303-550-6786

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  9360 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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