Provider Demographics
NPI:1750870713
Name:LEE, MIRANDA (LAC, CBP, LMT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC, CBP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 S OSCEOLA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2247
Mailing Address - Country:US
Mailing Address - Phone:720-310-8525
Mailing Address - Fax:
Practice Address - Street 1:7373 W JEFFERSON AVE STE 402
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2051
Practice Address - Country:US
Practice Address - Phone:720-310-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4441225700000X
CO2224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist