Provider Demographics
NPI:1275965055
Name:SEGRETTO, MICHELLE DOMINIQUE (,PT, DPT, COMT, CERT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOMINIQUE
Last Name:SEGRETTO
Suffix:
Gender:F
Credentials:,PT, DPT, COMT, CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:5300 TCHOUPITOULAS STREET, SUITE C1
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-703-3096
Practice Address - Fax:504-703-9101
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist