Provider Demographics
NPI:1962064725
Name:ADIX, MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ADIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:63497 160TH ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:MN
Mailing Address - Zip Code:56009-5563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 N MILL ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1303
Practice Address - Country:US
Practice Address - Phone:641-592-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist