Provider Demographics
NPI:1467649996
Name:REYES, MICHELE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:CREAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:4402 MENTONE ST
Mailing Address - Street 2:#206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1067
Mailing Address - Country:US
Mailing Address - Phone:619-384-0020
Mailing Address - Fax:
Practice Address - Street 1:4402 MENTONE ST
Practice Address - Street 2:#206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1067
Practice Address - Country:US
Practice Address - Phone:619-384-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010036L225100000X
CA21900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist