Provider Demographics
NPI:1417393620
Name:MICHAEL, TERI (PT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 E COTTON GIN LOOP STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8850
Mailing Address - Country:US
Mailing Address - Phone:866-308-2700
Mailing Address - Fax:866-438-0350
Practice Address - Street 1:4720 E COTTON GIN LOOP STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8850
Practice Address - Country:US
Practice Address - Phone:866-308-2700
Practice Address - Fax:866-438-0350
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist