Provider Demographics
NPI:1326429473
Name:HERBERT, MICHELE LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:HERBERT
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 1:14711 21ST AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-8124
Mailing Address - Country:US
Mailing Address - Phone:814-525-5113
Mailing Address - Fax:
Practice Address - Street 1:1120 33RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-6219
Practice Address - Country:US
Practice Address - Phone:941-746-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 29991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist