Provider Demographics
NPI:1497061642
Name:SUAREZ NEWBREY, MICHELLE JOSEPHINE (RPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOSEPHINE
Last Name:SUAREZ NEWBREY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMMOND STE C
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1680
Mailing Address - Country:US
Mailing Address - Phone:949-521-6658
Mailing Address - Fax:800-924-7223
Practice Address - Street 1:412 W AVENUE J STE G
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3685
Practice Address - Country:US
Practice Address - Phone:661-945-0884
Practice Address - Fax:661-942-9714
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ17904225100000X
CA8839225200000X
CA36762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant