Mikelle Marie Peterson, PT, DPT
Individual provider Active NPI Physical Therapist · Buena Vista, CO
NPI 1861476574 · NPPES record last updated Oct 1, 2018
Key facts
- NPI
- 1861476574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 7694 (CO)
- Practice address
- 29670 County Road 372a
Buena Vista, CO 81211-9704 - Phone
- (303) 862-1840
- NPI assigned
- Dec 6, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Body Mechanics Physical Therapy LLC
Practice addresses (Care Compare)
139 Crossman Ave
Buena Vista, CO 81211-9649
Phone (719) 966-5227
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050608000316 | CO | Practitioner - Physical Therapist in Private Practice | 0749223972 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7694 | CO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Body Mechanics Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
| MMP Inc | Physical Therapist | Past | Accepting new patients |
| Atlas Physical Therapy at Stapleton, PLLC | Physical Therapist | Past |
Accepting new patients |
| Purpose Medical Professional Corporation | Physical Therapist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7694 | CO | Yes |
Addresses
Primary practice location
29670 County Road 372a
Buena Vista, CO 81211-9704
Mailing address
29670 County Road 372a
Buena Vista, CO 81211-9704
Phone (303) 862-1840
Other practice location 1
3919 Tennyson St
Denver, CO 80212-2113
Phone (303) 477-5303
Other providers in Buena Vista, CO
- Janet D Ommen
- Craig Ronald Otteni
- Patricia Winter PHD PC
- Mikaila Heldt Pence
- Peter H Kuiper LCSW PC
- Abbey Lee Pikul
- Poet'S Glade
- Premier Home Care
- Premier Home Care Inc
- Premier Home Care, Inc
All providers in Buena Vista, CO · Physical Therapist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.