Provider Demographics
NPI:1942034277
Name:GEBREGIORGIS, MIKIYAS J (PT)
Entity type:Individual
Prefix:MR
First Name:MIKIYAS
Middle Name:J
Last Name:GEBREGIORGIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 TRUCKEE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8790
Mailing Address - Country:US
Mailing Address - Phone:720-691-6155
Mailing Address - Fax:
Practice Address - Street 1:10335 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-3622
Practice Address - Country:US
Practice Address - Phone:303-755-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0020026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist