Provider Demographics
NPI:1699916619
Name:MAHMOOD, MICHELE ELAINE (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ELAINE
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:ELAINE
Other - Last Name:FAVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3480 S QUAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5306
Mailing Address - Country:US
Mailing Address - Phone:303-728-4151
Mailing Address - Fax:
Practice Address - Street 1:7220 W JEFFERSON AVE STE 212
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2015
Practice Address - Country:US
Practice Address - Phone:303-578-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist