Provider Demographics
NPI:1154582682
Name:MICHEL, JESSICA LEIGH (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:MICHEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2187
Mailing Address - Country:US
Mailing Address - Phone:316-321-2663
Mailing Address - Fax:316-321-1194
Practice Address - Street 1:700 W CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2187
Practice Address - Country:US
Practice Address - Phone:316-321-2663
Practice Address - Fax:316-321-1194
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-09145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist