Provider Demographics
NPI:1689627630
Name:BABCOCK, MICHELLE MARIE (PT MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PT MSPT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:DEMENEZES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MSPT
Mailing Address - Street 1:9097 E DESERT COVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:16611 S 40TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0562
Practice Address - Country:US
Practice Address - Phone:480-706-1199
Practice Address - Fax:480-706-3999
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ82992Medicare ID - Type Unspecified
AZ116913Medicare PIN