Provider Demographics
NPI:1528066883
Name:MICHAELSON, BARRY SCOTT (MPT)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:SCOTT
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1309 PINE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3731
Mailing Address - Country:US
Mailing Address - Phone:410-486-0275
Mailing Address - Fax:410-486-0276
Practice Address - Street 1:8051 PALOMAS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5284
Practice Address - Country:US
Practice Address - Phone:410-486-0275
Practice Address - Fax:410-486-0276
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178222251G0304X, 2251X0800X, 2251E1200X
NMPT4367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD143300800Medicaid
MDR93484Medicare UPIN