Provider Demographics
NPI:1073680286
Name:MICHALAK, MICHELLE L (ATC CSCS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:ATC CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 HEATHER MOSS DR
Mailing Address - Street 2:#1502
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5552
Mailing Address - Country:US
Mailing Address - Phone:630-750-3369
Mailing Address - Fax:
Practice Address - Street 1:5165 ADANSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1331
Practice Address - Country:US
Practice Address - Phone:630-750-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine