Provider Demographics
NPI:1376799734
Name:MERRITT, MICHELLE E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:REY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:13645 MOUNT BALDY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-1408
Mailing Address - Country:US
Mailing Address - Phone:775-624-4429
Mailing Address - Fax:
Practice Address - Street 1:13645 MOUNT BALDY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506
Practice Address - Country:US
Practice Address - Phone:775-624-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2494225100000X
CA34863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376799734Medicaid
NVBW211YMedicare Oscar/Certification