Provider Demographics
NPI:1467124909
Name:MICHAELS, JOHN JR (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MICHAELS
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WILKINSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-4937
Mailing Address - Country:US
Mailing Address - Phone:864-490-6671
Mailing Address - Fax:
Practice Address - Street 1:1445 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4735
Practice Address - Country:US
Practice Address - Phone:864-487-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic