Provider Demographics
NPI:1699943530
Name:CERRA, MICHELINE (PT)
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:CERRA
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 1:647 GRAND VIEW AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3537
Mailing Address - Country:US
Mailing Address - Phone:917-703-3343
Mailing Address - Fax:
Practice Address - Street 1:647 GRAND VIEW AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3537
Practice Address - Country:US
Practice Address - Phone:917-703-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist