Provider Demographics
NPI:1417387416
Name:MICHAELS, MELISSA (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HREHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:144 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2132
Mailing Address - Country:US
Mailing Address - Phone:732-316-5895
Mailing Address - Fax:
Practice Address - Street 1:144 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2132
Practice Address - Country:US
Practice Address - Phone:732-316-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01502800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation