Provider Demographics
NPI:1073152872
Name:MENARD, MICHELLE DOLORES (PT/DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOLORES
Last Name:MENARD
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DOLORES
Other - Last Name:SYNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT/DPT
Mailing Address - Street 1:3418 LOMA VISTA RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3016
Mailing Address - Country:US
Mailing Address - Phone:805-765-4773
Mailing Address - Fax:
Practice Address - Street 1:3418 LOMA VISTA RD STE 4A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3016
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist