Provider Demographics
NPI:1619425345
Name:FERRERA, MICHELLE LUCERO (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LUCERO
Last Name:FERRERA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:BLANCAFLOR
Other - Last Name:LUCERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:13137 SORRENTO RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8777
Mailing Address - Country:US
Mailing Address - Phone:850-416-0025
Mailing Address - Fax:
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist