Provider Demographics
NPI:1114053519
Name:ZEOLLA, MICHELE ALDEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ALDEN
Last Name:ZEOLLA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 KANAN ROAD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1688
Mailing Address - Country:US
Mailing Address - Phone:818-889-0158
Mailing Address - Fax:818-889-4708
Practice Address - Street 1:5927 KANAN ROAD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:818-889-0158
Practice Address - Fax:818-889-4708
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT176710OtherBLUE SHIELD OF CA
7126624OtherAETNA INS CO
PT176710OtherBLUE SHIELD OF CA