Provider Demographics
NPI:1235171901
Name:MICHALS, CARON (PT)
Entity Type:Individual
Prefix:
First Name:CARON
Middle Name:
Last Name:MICHALS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 S 56TH ST
Mailing Address - Street 2:#1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3392
Mailing Address - Country:US
Mailing Address - Phone:402-420-0800
Mailing Address - Fax:402-420-0801
Practice Address - Street 1:6101 S 56TH ST
Practice Address - Street 2:#1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3392
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:402-420-0801
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275337Medicare PIN