Provider Demographics
NPI:1760561005
Name:KLAREN, MICHELLE COLMAN (MSPT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:COLMAN
Last Name:KLAREN
Suffix:
Gender:F
Credentials:MSPT, DPT, OCS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:COLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 3RD AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4938
Mailing Address - Country:US
Mailing Address - Phone:619-537-9506
Mailing Address - Fax:
Practice Address - Street 1:8901 ACTIVITY RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4427
Practice Address - Country:US
Practice Address - Phone:619-535-6900
Practice Address - Fax:619-535-6901
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367312251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA183545Medicare PIN
CACA183544Medicare PIN
CACA183546Medicare PIN
CACB248516Medicare PIN