Provider Demographics
NPI:1316508641
Name:WARE, MICHELLE NICHOLE (MT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICHOLE
Last Name:WARE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 FUNDY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7508
Mailing Address - Country:US
Mailing Address - Phone:303-641-2068
Mailing Address - Fax:
Practice Address - Street 1:15101 E ILIFF AVE STE 250
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4552
Practice Address - Country:US
Practice Address - Phone:303-641-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist