Provider Demographics
NPI:1003401415
Name:DEAN, MICHALA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHALA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 ATHLETIC DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-4433
Mailing Address - Country:US
Mailing Address - Phone:802-985-4440
Mailing Address - Fax:
Practice Address - Street 1:166 ATHLETIC DR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-4433
Practice Address - Country:US
Practice Address - Phone:802-985-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist