Provider Demographics
NPI:1275663411
Name:DAVE, MICHELE L (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:DAVE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5605
Mailing Address - Country:US
Mailing Address - Phone:239-676-2080
Mailing Address - Fax:
Practice Address - Street 1:4800 ASTON GARDENS WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3501
Practice Address - Country:US
Practice Address - Phone:239-676-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35667225100000X
NJ4OQAO1131300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist