Provider Demographics
NPI:1659748739
Name:SCALA, MICHILINA T
Entity Type:Individual
Prefix:DR
First Name:MICHILINA
Middle Name:T
Last Name:SCALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RIVER AVE
Mailing Address - Street 2:BLDG 10C
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5657
Mailing Address - Country:US
Mailing Address - Phone:732-534-6707
Mailing Address - Fax:732-534-6703
Practice Address - Street 1:1200 RIVER AVE
Practice Address - Street 2:BLDG 10C
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5657
Practice Address - Country:US
Practice Address - Phone:732-534-6707
Practice Address - Fax:732-534-6703
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA005571NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist