Provider Demographics
NPI:1073347399
Name:MILE HIGH LYMPHEDEMA CARE
Entity type:Organization
Organization Name:MILE HIGH LYMPHEDEMA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROWEN
Authorized Official - Middle Name:MARS
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT-LANA
Authorized Official - Phone:805-704-3052
Mailing Address - Street 1:400 N GRANT ST UNIT 119
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4488
Mailing Address - Country:US
Mailing Address - Phone:805-704-3052
Mailing Address - Fax:
Practice Address - Street 1:400 N GRANT ST UNIT 119
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4488
Practice Address - Country:US
Practice Address - Phone:805-704-3052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health