Provider Demographics
NPI:1346426483
Name:MICHAUD, DOROTHY L (LPTA)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:L
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:L
Other - Last Name:SENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:1905 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3013
Mailing Address - Country:US
Mailing Address - Phone:731-618-8282
Mailing Address - Fax:
Practice Address - Street 1:2865 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3070
Practice Address - Country:US
Practice Address - Phone:731-824-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant