Provider Demographics
NPI:1528497476
Name:HANEY, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HANEY
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 1:1289 S LINDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3499
Mailing Address - Country:US
Mailing Address - Phone:248-857-6776
Mailing Address - Fax:248-857-7102
Practice Address - Street 1:8273 S SAGINAW ST STE B
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2465
Practice Address - Country:US
Practice Address - Phone:810-579-7184
Practice Address - Fax:810-230-8799
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7259001Medicare PIN