Provider Demographics
NPI:1881689677
Name:ACCARDO, MICHELLE (ATC,RMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ACCARDO
Suffix:
Gender:F
Credentials:ATC,RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 OAK LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2971
Mailing Address - Country:US
Mailing Address - Phone:817-800-8205
Mailing Address - Fax:
Practice Address - Street 1:610 OAK LN
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2971
Practice Address - Country:US
Practice Address - Phone:817-800-8205
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT12762255A2300X
TXMT017269225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist