Provider Demographics
NPI:1174007843
Name:LEVIN, MICHAEL JASON (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JASON
Last Name:LEVIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56171 E COLFAX AVE #6
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136
Mailing Address - Country:US
Mailing Address - Phone:772-631-1752
Mailing Address - Fax:
Practice Address - Street 1:56171 E COLFAX AVE #6
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136
Practice Address - Country:US
Practice Address - Phone:772-631-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist