Provider Demographics
NPI:1104019710
Name:GUEVIN, MICHELLE S (PT DPT MHSC MTC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:GUEVIN
Suffix:
Gender:F
Credentials:PT DPT MHSC MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 CORTEZ RD W
Mailing Address - Street 2:STE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3145
Mailing Address - Country:US
Mailing Address - Phone:941-739-7828
Mailing Address - Fax:941-739-7838
Practice Address - Street 1:3637 CORTEZ RD W
Practice Address - Street 2:STE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3145
Practice Address - Country:US
Practice Address - Phone:941-739-7828
Practice Address - Fax:941-739-7838
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7409208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7443ZMedicare UPIN