Provider Demographics
NPI:1528159506
Name:CRESENCIA, MICHELLE SUSAN MARIE (MPT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUSAN MARIE
Last Name:CRESENCIA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9873 BAYWINDS DRIVE
Mailing Address - Street 2:SUITE - 5211
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-906-0606
Mailing Address - Fax:
Practice Address - Street 1:10220 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9332
Practice Address - Country:US
Practice Address - Phone:561-753-5610
Practice Address - Fax:561-795-8653
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL22283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist