Provider Demographics
NPI:1881654762
Name:PARCELL, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PARCELL
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 1:8843 CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-2111
Mailing Address - Country:US
Mailing Address - Phone:951-833-4675
Mailing Address - Fax:
Practice Address - Street 1:1113 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4455
Practice Address - Country:US
Practice Address - Phone:951-737-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT151681Medicare ID - Type UnspecifiedMEDICARE