Provider Demographics
NPI:1003409673
Name:MICHEL, CLARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:1060 EAGLES LANDING PKWY STE 130
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9091
Practice Address - Country:US
Practice Address - Phone:470-369-5770
Practice Address - Fax:470-369-5771
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT015121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist