Provider Demographics
NPI:1275669384
Name:GLUCK, MICHELLE STACEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:STACEY
Last Name:GLUCK
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 1:6141 NW 58TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4441
Mailing Address - Country:US
Mailing Address - Phone:954-663-1539
Mailing Address - Fax:954-255-0665
Practice Address - Street 1:6141 NW 58TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4441
Practice Address - Country:US
Practice Address - Phone:954-663-1539
Practice Address - Fax:954-255-0665
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist