Provider Demographics
NPI:1841244928
Name:CAZALAS, MICHELE KATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:KATHERINE
Last Name:CAZALAS
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:PO BOX 2736
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91979-2736
Mailing Address - Country:US
Mailing Address - Phone:619-573-6373
Mailing Address - Fax:619-378-6578
Practice Address - Street 1:2082 POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-2018
Practice Address - Country:US
Practice Address - Phone:619-838-6158
Practice Address - Fax:619-660-0495
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB207119Medicare PIN