Provider Demographics
NPI:1114429867
Name:RAWLYK, MICHELLE AUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AUSTIN
Last Name:RAWLYK
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 1:5310 N OCEAN BLVD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2531
Mailing Address - Country:US
Mailing Address - Phone:804-683-7363
Mailing Address - Fax:
Practice Address - Street 1:5310 N OCEAN BLVD UNIT 501
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2531
Practice Address - Country:US
Practice Address - Phone:804-683-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer