Provider Demographics
NPI:1326675372
Name:AUDET, MICHELE ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELLEN
Last Name:AUDET
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 1:1529 SAGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1205
Mailing Address - Country:US
Mailing Address - Phone:404-580-3995
Mailing Address - Fax:
Practice Address - Street 1:1529 SAGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1205
Practice Address - Country:US
Practice Address - Phone:404-580-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist