Provider Demographics
NPI:1588740732
Name:BOLES, MICHELLE ANN (DOCTOR OF PHYSICAL T)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:BOLES
Suffix:
Gender:F
Credentials:DOCTOR OF PHYSICAL T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8375
Mailing Address - Country:US
Mailing Address - Phone:704-691-1016
Mailing Address - Fax:704-691-1016
Practice Address - Street 1:4081 CASCADE DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8375
Practice Address - Country:US
Practice Address - Phone:704-691-1016
Practice Address - Fax:704-691-1016
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist