Provider Demographics
NPI:1972167641
Name:MCMICHAEL, JAMES (MSPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MCMICHAEL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 CORNERSTONE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8266
Mailing Address - Country:US
Mailing Address - Phone:970-507-8668
Mailing Address - Fax:970-507-3636
Practice Address - Street 1:2839 CORNERSTONE DR STE 3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8266
Practice Address - Country:US
Practice Address - Phone:970-507-8668
Practice Address - Fax:970-507-3636
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist