Provider Demographics
NPI:1659538718
Name:ROONEY, MICHELE (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:ROONEY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:ROONEY
Other - Last Name:HARRIMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PT
Mailing Address - Street 1:12460 CAMINITO MIRA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2368
Mailing Address - Country:US
Mailing Address - Phone:619-804-1630
Mailing Address - Fax:858-217-4139
Practice Address - Street 1:12460 CAMINITO MIRA DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2368
Practice Address - Country:US
Practice Address - Phone:619-804-1630
Practice Address - Fax:858-217-4139
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist