Provider Demographics
NPI:1225382039
Name:CHRISTENSEN, MICHELLE L (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:843 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6577
Mailing Address - Country:US
Mailing Address - Phone:919-570-7080
Mailing Address - Fax:919-570-7081
Practice Address - Street 1:843 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE 110
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6577
Practice Address - Country:US
Practice Address - Phone:919-570-7080
Practice Address - Fax:919-570-7081
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14012OtherNORTH CAROLINA PHYSICAL THERAPY BOARD