Provider Demographics
NPI:1699072355
Name:MICHELI, RALPH A (PT)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:MICHELI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20210 MAKAH ST NW
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4872
Mailing Address - Country:US
Mailing Address - Phone:763-229-8183
Mailing Address - Fax:763-208-2347
Practice Address - Street 1:20210 MAKAH ST NW
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MN
Practice Address - Zip Code:55303-4872
Practice Address - Country:US
Practice Address - Phone:763-229-8183
Practice Address - Fax:763-208-2347
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist