Provider Demographics
NPI:1992285886
Name:ALVAREZ, MICHELLE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5545
Mailing Address - Country:US
Mailing Address - Phone:706-993-2272
Mailing Address - Fax:706-842-6752
Practice Address - Street 1:1241 FRIENDSHIP RD STE 120
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517
Practice Address - Country:US
Practice Address - Phone:706-993-2272
Practice Address - Fax:706-842-6752
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT013566OtherGA LICENSE NUMBER