Provider Demographics
NPI:1912224601
Name:HARDEE, MICHELE ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:HARDEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 EDGEWATER CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9347
Mailing Address - Country:US
Mailing Address - Phone:910-686-5468
Mailing Address - Fax:
Practice Address - Street 1:1011 PORTERS NECK ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-686-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2503225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant