Provider Demographics
NPI:1194967471
Name:MEANOR, MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MEANOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 FOOTHILL DR.
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:760-777-3573
Mailing Address - Fax:951-922-0648
Practice Address - Street 1:880 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-1221
Practice Address - Country:US
Practice Address - Phone:760-777-3573
Practice Address - Fax:951-922-0648
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist