Provider Demographics
NPI:1982130340
Name:FELICIANO, MICHAEL E (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 ROCKROSE LN BLDG H22
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8268
Mailing Address - Country:US
Mailing Address - Phone:787-245-9707
Mailing Address - Fax:
Practice Address - Street 1:1441 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1864
Practice Address - Country:US
Practice Address - Phone:787-245-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0002882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer