Provider Demographics
NPI:1932928793
Name:CAYNA, MICHELLE TABASA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TABASA
Last Name:CAYNA
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 1:311 FINDLEY CHASE LN
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1892
Mailing Address - Country:US
Mailing Address - Phone:317-675-9440
Mailing Address - Fax:
Practice Address - Street 1:2002 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1824
Practice Address - Country:US
Practice Address - Phone:229-382-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist