Provider Demographics
NPI:1417289505
Name:STERN, MICHAEL ZALE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ZALE
Last Name:STERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ZALE
Other - Last Name:RATTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 W JAMES LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2638
Mailing Address - Country:US
Mailing Address - Phone:850-689-2260
Mailing Address - Fax:
Practice Address - Street 1:424 W JAMES LEE BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2638
Practice Address - Country:US
Practice Address - Phone:850-689-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist