Provider Demographics
NPI:1639227408
Name:GUST, MICHELE LYNN (BS PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:GUST
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2513
Mailing Address - Country:US
Mailing Address - Phone:305-297-4661
Mailing Address - Fax:305-273-5754
Practice Address - Street 1:11610 SW 98TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2513
Practice Address - Country:US
Practice Address - Phone:305-297-4661
Practice Address - Fax:305-273-5754
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7226Medicare ID - Type Unspecified