Provider Demographics
NPI:1306134242
Name:SCHIEWE, MICHELLE JOAN (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOAN
Last Name:SCHIEWE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VIA MORELLA
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5388
Mailing Address - Country:US
Mailing Address - Phone:858-487-4770
Mailing Address - Fax:585-487-5013
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 106
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-487-4770
Practice Address - Fax:858-487-5013
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH591ZMedicare UPIN