Provider Demographics
NPI:1104362839
Name:PHEBUS, MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PHEBUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 LORGNETTE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1635
Mailing Address - Country:US
Mailing Address - Phone:443-844-6696
Mailing Address - Fax:
Practice Address - Street 1:1812 LORGNETTE CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1635
Practice Address - Country:US
Practice Address - Phone:443-844-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0000632246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other