Provider Demographics
NPI:1679813539
Name:DAUS, MICHELLE SUDARIA (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUDARIA
Last Name:DAUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6695 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4235
Mailing Address - Country:US
Mailing Address - Phone:562-596-7074
Mailing Address - Fax:562-596-7214
Practice Address - Street 1:6695 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4235
Practice Address - Country:US
Practice Address - Phone:562-596-7074
Practice Address - Fax:562-596-7214
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist