Provider Demographics
NPI:1609489830
Name:PEARSON, MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PEARSON
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 1:268 GLENN ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5810
Mailing Address - Country:US
Mailing Address - Phone:704-591-5025
Mailing Address - Fax:
Practice Address - Street 1:1460 E GASTON ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4400
Practice Address - Country:US
Practice Address - Phone:980-212-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0003157225100000X
NCP9278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist