Provider Demographics
NPI:1821013897
Name:PRESTON-SMITH, MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PRESTON-SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE RD STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:209-576-0888
Mailing Address - Fax:209-576-0913
Practice Address - Street 1:3184 COLLINS DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3132
Practice Address - Country:US
Practice Address - Phone:209-230-5289
Practice Address - Fax:209-222-6185
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT152720Medicare ID - Type Unspecified
CAP64372Medicare UPIN