Provider Demographics
NPI:1891039053
Name:ANGE, MICHAELLA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAELLA
Middle Name:
Last Name:ANGE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MICHAELLA
Other - Middle Name:
Other - Last Name:CORMIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:3221 RYAN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8780
Mailing Address - Country:US
Mailing Address - Phone:337-439-3344
Mailing Address - Fax:337-439-3380
Practice Address - Street 1:3221 RYAN ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8780
Practice Address - Country:US
Practice Address - Phone:337-439-3344
Practice Address - Fax:337-439-3380
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08480208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation