Provider Demographics
NPI:1659659886
Name:VALENCSIN, MICHELLE DAWN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:VALENCSIN
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 1:1101 BROADWAY AVE STE 115B
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2836
Mailing Address - Country:US
Mailing Address - Phone:605-260-5003
Mailing Address - Fax:605-260-5005
Practice Address - Street 1:1101 BROADWAY AVE STE 115B
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2836
Practice Address - Country:US
Practice Address - Phone:605-260-5003
Practice Address - Fax:605-260-5005
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist