Provider Demographics
NPI:1790194785
Name:JAY, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39180 FARWELL DR
Mailing Address - Street 2:SUITE 231
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1000
Mailing Address - Country:US
Mailing Address - Phone:510-585-2545
Mailing Address - Fax:
Practice Address - Street 1:39180 FARWELL DR
Practice Address - Street 2:SUITE 231
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1000
Practice Address - Country:US
Practice Address - Phone:510-585-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2395225100000X
CA22054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist