Provider Demographics
NPI:1316439391
Name:CRUCE, MICAELA TASHA
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:TASHA
Last Name:CRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:TASHA
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17489 E TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1905
Mailing Address - Country:US
Mailing Address - Phone:303-945-0052
Mailing Address - Fax:
Practice Address - Street 1:2828 N SPEER BLVD UNIT 117
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4215
Practice Address - Country:US
Practice Address - Phone:303-945-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0009079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist