Provider Demographics
NPI:1346789153
Name:PIETTE, MICHELLE (AT,C LAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PIETTE
Suffix:
Gender:F
Credentials:AT,C LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 FALLS OF NEUSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5316
Mailing Address - Country:US
Mailing Address - Phone:919-847-0900
Mailing Address - Fax:
Practice Address - Street 1:7409 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5316
Practice Address - Country:US
Practice Address - Phone:919-369-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-03262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer