Provider Demographics
NPI:1114909504
Name:FORNADEL, MICHELLE MARIE (MHS, PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:FORNADEL
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087
Mailing Address - Country:US
Mailing Address - Phone:330-888-4000
Mailing Address - Fax:
Practice Address - Street 1:8701 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2105
Practice Address - Country:US
Practice Address - Phone:330-888-4000
Practice Address - Fax:330-888-4000
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH054262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic