Provider Demographics
NPI:1093815466
Name:ZENDA, MICHELLE MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:ZENDA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:ZENDA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4400 CAPITOLA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3571
Mailing Address - Country:US
Mailing Address - Phone:831-426-9302
Mailing Address - Fax:408-378-4510
Practice Address - Street 1:4400 CAPITOLA RD STE 200
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3571
Practice Address - Country:US
Practice Address - Phone:831-426-9302
Practice Address - Fax:408-378-4510
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist