Provider Demographics
NPI:1225343569
Name:ZELENA, MICHELLE (DSC, PT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:ZELENA
Suffix:
Gender:F
Credentials:DSC, PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PROWSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSC, PT
Mailing Address - Street 1:4225 JADE ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3918
Mailing Address - Country:US
Mailing Address - Phone:405-269-9164
Mailing Address - Fax:
Practice Address - Street 1:1200 41ST AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3900
Practice Address - Country:US
Practice Address - Phone:831-475-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36989225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist