Provider Demographics
NPI:1508559733
Name:BATTLE, MICHAELA (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BATTLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ADAMS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1171
Mailing Address - Country:US
Mailing Address - Phone:443-622-9994
Mailing Address - Fax:
Practice Address - Street 1:5525 ADAMS RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1171
Practice Address - Country:US
Practice Address - Phone:443-622-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant