Provider Demographics
NPI:1588951289
Name:YANG, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 ELIZABETH ST
Mailing Address - Street 2:APT.26C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4751
Mailing Address - Country:US
Mailing Address - Phone:917-620-2268
Mailing Address - Fax:
Practice Address - Street 1:96 ELIZABETH ST
Practice Address - Street 2:APT.26C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4751
Practice Address - Country:US
Practice Address - Phone:917-620-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist