Provider Demographics
NPI:1326581661
Name:MCMICHEL, JACQUELINE PATRICE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:PATRICE
Last Name:MCMICHEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:PATRICE
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1710 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3764
Mailing Address - Country:US
Mailing Address - Phone:615-383-2557
Mailing Address - Fax:615-292-2061
Practice Address - Street 1:1710 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3764
Practice Address - Country:US
Practice Address - Phone:615-383-2557
Practice Address - Fax:615-292-2061
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6016225200000X
IN06004354A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant