Provider Demographics
NPI:1780864694
Name:SIEGEL, MICHAEL ARTHUR (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE
Mailing Address - Street 2:SUITE 204-C
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2172
Mailing Address - Country:US
Mailing Address - Phone:831-476-2247
Mailing Address - Fax:831-476-2247
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:SUITE 204-C
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2172
Practice Address - Country:US
Practice Address - Phone:831-476-2247
Practice Address - Fax:831-476-2247
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist