Provider Demographics
NPI:1114784493
Name:MARKLEY, MICHELLE L (LPTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:MARKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:11988 E LASSWELL RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427-5102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11988 E LASSWELL RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:IL
Practice Address - Zip Code:61427-5102
Practice Address - Country:US
Practice Address - Phone:309-224-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002273225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant