Provider Demographics
NPI:1144236811
Name:MICHAELS, GRETCHEN ELISA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELISA
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 ALEXIS CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6175
Mailing Address - Country:US
Mailing Address - Phone:410-553-0950
Mailing Address - Fax:410-590-4365
Practice Address - Street 1:8131 RITCHIE HWY
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6940
Practice Address - Country:US
Practice Address - Phone:410-590-4360
Practice Address - Fax:410-590-4365
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529392-04OtherBCBS OF MD RENDERING #
MD215719OtherKAISER PERMANENTE
MD2437714OtherAETNA
DC47610070OtherCAREFIRST RENDERING #
MD529392-04OtherBCBS OF MD RENDERING #