Provider Demographics
NPI:1275272247
Name:MAGRY, MICHAELA (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MAGRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 WILLOUGHBY RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9413
Mailing Address - Country:US
Mailing Address - Phone:248-220-3510
Mailing Address - Fax:
Practice Address - Street 1:148 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:MI
Practice Address - Zip Code:49251-2561
Practice Address - Country:US
Practice Address - Phone:517-589-9050
Practice Address - Fax:517-589-9059
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant