Provider Demographics
NPI:1699161737
Name:MICHAEL, MICHELE ELAINE (MSPT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELAINE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9690 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1256
Mailing Address - Country:US
Mailing Address - Phone:951-252-7746
Mailing Address - Fax:877-748-6803
Practice Address - Street 1:5701 CRESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-4962
Practice Address - Country:US
Practice Address - Phone:310-377-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist