Basic Information
| Provider Information | |||||||||
| NPI: | 1669063046 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPONEMAN | ||||||||
| FirstName: | MIRANDA | ||||||||
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| Credential: | DPT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 FILLMORE ST | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802064321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185588492 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8670 WOLFF CT STE 115 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800313692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036501700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2021 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0015708 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.