Provider Demographics
NPI:1609997345
Name:BROWN, MICHELLE M (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:BERGEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2015 W VIA RANCHO PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029
Mailing Address - Country:US
Mailing Address - Phone:760-644-5990
Mailing Address - Fax:
Practice Address - Street 1:2015 W VIA RANCHO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-6511
Practice Address - Country:US
Practice Address - Phone:760-644-5990
Practice Address - Fax:760-644-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist