Provider Demographics
NPI:1689782138
Name:MICHALSKI, MONICA JEAN (MPT, OCS, CERT MDT)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JEAN
Last Name:MICHALSKI
Suffix:
Gender:F
Credentials:MPT, OCS, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HERTITAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4535
Mailing Address - Country:US
Mailing Address - Phone:561-635-8242
Mailing Address - Fax:
Practice Address - Street 1:600 HERTITAGE DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33410-4535
Practice Address - Country:US
Practice Address - Phone:561-635-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7156225100000X
FL133172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079194Medicaid
AZ079194Medicaid