Provider Demographics
NPI:1114557451
Name:CHELLEW, MICHELLE SIMONE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SIMONE
Last Name:CHELLEW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 EMERALD COAST PKWY W
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7274
Mailing Address - Country:US
Mailing Address - Phone:850-278-3770
Mailing Address - Fax:
Practice Address - Street 1:9375 EMERALD COAST PKWY W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7274
Practice Address - Country:US
Practice Address - Phone:850-278-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32435208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation