Provider Demographics
NPI:1851609036
Name:SHIN, MICHAEL YONG (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YONG
Last Name:SHIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 PEACHTREE INDUSTRIAL BLVD 500E
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1663
Mailing Address - Country:US
Mailing Address - Phone:678-718-5240
Mailing Address - Fax:844-860-3356
Practice Address - Street 1:4350 PEACHTREE INDUSTRIAL BLVD 500E
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1663
Practice Address - Country:US
Practice Address - Phone:678-718-5240
Practice Address - Fax:844-860-3356
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist