Provider Demographics
NPI:1891845871
Name:CARAVELLO, MICHELLE ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:CARAVELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:KEOHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8050 OLD COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6457
Mailing Address - Country:US
Mailing Address - Phone:727-375-0600
Mailing Address - Fax:727-371-1117
Practice Address - Street 1:1273 KASS CIR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4308
Practice Address - Country:US
Practice Address - Phone:352-683-3866
Practice Address - Fax:352-683-3867
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224562251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35514JOtherWILLCARE
FLY097BOtherBCBS
FL14430901OtherCITRUS HMO
FL891234300Medicaid