Provider Demographics
NPI:1891253977
Name:PANZL, MICHELLE FADOOL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FADOOL
Last Name:PANZL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HORIZON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4946
Mailing Address - Country:US
Mailing Address - Phone:919-875-1932
Mailing Address - Fax:919-875-1933
Practice Address - Street 1:200 HORIZON DR STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4947
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18662208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP18662OtherLICENSE NUMBER